Provider Demographics
NPI:1235255522
Name:CONWAY, BRIDGET ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANN
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 MCDOW DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2415
Mailing Address - Country:US
Mailing Address - Phone:803-366-5722
Mailing Address - Fax:
Practice Address - Street 1:831 MCDOW DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2415
Practice Address - Country:US
Practice Address - Phone:803-366-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3475235Z00000X
NC5731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist