Provider Demographics
NPI:1053489328
Name:DIMANT, BRIDGETT ELAINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETT
Middle Name:ELAINE
Last Name:DIMANT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:13750 W COLONIAL DR STE 350-121
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4204
Mailing Address - Country:US
Mailing Address - Phone:407-285-7907
Mailing Address - Fax:407-992-9368
Practice Address - Street 1:301 S TUBB ST STE A-1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34760
Practice Address - Country:US
Practice Address - Phone:407-285-7907
Practice Address - Fax:407-992-9368
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL010665400222Q00000X
FLSZ 3968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010665400Medicaid
FL890306900Medicaid