Provider Demographics
NPI:1033254677
Name:J. ALLEN BRIDGMAN PEDIATRIC SPEECH PATHOLOGY, PLLC
Entity type:Organization
Organization Name:J. ALLEN BRIDGMAN PEDIATRIC SPEECH PATHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BRIDGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:502-314-5884
Mailing Address - Street 1:212 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2731
Mailing Address - Country:US
Mailing Address - Phone:502-314-5884
Mailing Address - Fax:502-897-9893
Practice Address - Street 1:212 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2731
Practice Address - Country:US
Practice Address - Phone:502-314-5884
Practice Address - Fax:502-897-9893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2246251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health