Provider Demographics
NPI:1346797933
Name:GRIFFIN, BRIDGER (BA, BS, MS)
Entity Type:Individual
Prefix:
First Name:BRIDGER
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:BA, BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 NE 159TH ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4349
Mailing Address - Country:US
Mailing Address - Phone:207-615-6554
Mailing Address - Fax:
Practice Address - Street 1:8301 16ST AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-882-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60677413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist