Provider Demographics
NPI:1316595309
Name:DENNIS, BRIDGETTE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:652 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:IL
Mailing Address - Zip Code:61427-5211
Mailing Address - Country:US
Mailing Address - Phone:309-785-8054
Mailing Address - Fax:
Practice Address - Street 1:652 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:IL
Practice Address - Zip Code:61427-5211
Practice Address - Country:US
Practice Address - Phone:309-785-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist