Provider Demographics
NPI:1013409085
Name:HAHN SOUTHWOOD, BRIDGET LOUISE (LPCA)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:LOUISE
Last Name:HAHN SOUTHWOOD
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GENE CASH RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-4908
Mailing Address - Country:US
Mailing Address - Phone:270-465-7768
Mailing Address - Fax:
Practice Address - Street 1:50 GENE CASH RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-4908
Practice Address - Country:US
Practice Address - Phone:270-465-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid