Provider Demographics
NPI:1356627533
Name:BRIDGES, INGRID KRISTINE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:KRISTINE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23323 W LAKE PLACE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544
Mailing Address - Country:US
Mailing Address - Phone:630-956-1566
Mailing Address - Fax:
Practice Address - Street 1:23819 W MILL ST.
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:630-956-1566
Practice Address - Fax:630-920-1796
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional