Provider Demographics
NPI:1164764007
Name:BRIDGES, JENNIFER CAROLINE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROLINE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CAROLINE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 E MORTON ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-2778
Mailing Address - Country:US
Mailing Address - Phone:903-819-2704
Mailing Address - Fax:
Practice Address - Street 1:833 E MORTON ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75021-2778
Practice Address - Country:US
Practice Address - Phone:903-819-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker