Provider Demographics
NPI:1487067781
Name:BRIDGSTOCK, MATTHEW (LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BRIDGSTOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W 100 N # 202A
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1611
Mailing Address - Country:US
Mailing Address - Phone:801-380-5998
Mailing Address - Fax:385-313-0311
Practice Address - Street 1:12 W 100 N # 202A
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1611
Practice Address - Country:US
Practice Address - Phone:801-896-4389
Practice Address - Fax:385-313-0311
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5593904-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical