Provider Demographics
NPI:1174727895
Name:SUDDERTH, BRIDGET GAIL (LMFT)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:GAIL
Last Name:SUDDERTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 N MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3024
Mailing Address - Country:US
Mailing Address - Phone:405-226-0644
Mailing Address - Fax:405-395-0255
Practice Address - Street 1:1601 N KICKAPOO AVE STE 900
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4313
Practice Address - Country:US
Practice Address - Phone:405-585-6413
Practice Address - Fax:405-395-0255
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist