Provider Demographics
NPI:1255483517
Name:BRIDGES, NANCY A (AUD, CCC/A)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:AUD, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 KINGWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3135
Mailing Address - Country:US
Mailing Address - Phone:281-312-3277
Mailing Address - Fax:
Practice Address - Street 1:1202 KINGWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3135
Practice Address - Country:US
Practice Address - Phone:281-312-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51726231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2096802Medicaid
TX2096802Medicaid