Provider Demographics
NPI:1093921306
Name:KANE, BRIDGET R (MA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:R
Last Name:KANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 135
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558
Mailing Address - Country:US
Mailing Address - Phone:630-910-8977
Mailing Address - Fax:
Practice Address - Street 1:LAGRANGE HOSPITAL AMBULATORY CARE
Practice Address - Street 2:5101 S WILLOW SPRINGS RD.
Practice Address - City:LAGRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:630-910-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000324231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49568Medicare PIN