Provider Demographics
NPI:1407446008
Name:BRIDGES, MICHELL DEANN
Entity Type:Individual
Prefix:
First Name:MICHELL
Middle Name:DEANN
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E DIXON BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-7099
Mailing Address - Country:US
Mailing Address - Phone:704-487-1128
Mailing Address - Fax:
Practice Address - Street 1:1506 E DIXON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7099
Practice Address - Country:US
Practice Address - Phone:704-487-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1579237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist