Provider Demographics
NPI:1275507840
Name:COCOLA, BRIDGET E (SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:E
Last Name:COCOLA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:E
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:243 WOODROW WILSON LANE
Mailing Address - Street 2:PO BOX 1500 BOX W-1
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-332-7086
Mailing Address - Fax:
Practice Address - Street 1:243 WOODROW WILSON LANE
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-332-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA494515Medicare ID - Type Unspecified