Provider Demographics
NPI:1184014821
Name:BRIDEWELL, STEPHEN (SOCIOLOGY, (BA))
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:BRIDEWELL
Suffix:
Gender:M
Credentials:SOCIOLOGY, (BA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3321
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-3321
Mailing Address - Country:US
Mailing Address - Phone:405-341-9989
Mailing Address - Fax:
Practice Address - Street 1:614 E 27TH PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5219
Practice Address - Country:US
Practice Address - Phone:405-341-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker