Provider Demographics
NPI:1174344840
Name:BRIDGES, TAMA MARIE
Entity type:Individual
Prefix:
First Name:TAMA
Middle Name:MARIE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 6TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081
Mailing Address - Country:US
Mailing Address - Phone:507-621-2006
Mailing Address - Fax:
Practice Address - Street 1:904 6TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081
Practice Address - Country:US
Practice Address - Phone:507-621-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician