Provider Demographics
NPI:1407224017
Name:BRIDGFORD, CANDICE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:BRIDGFORD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 KAROL KAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2004
Mailing Address - Country:US
Mailing Address - Phone:402-643-2986
Mailing Address - Fax:
Practice Address - Street 1:2401 KAROL KAY BLVD
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2004
Practice Address - Country:US
Practice Address - Phone:402-643-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist