Provider Demographics
NPI:1457662850
Name:MESSINA, BRIDGET C (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:C
Last Name:MESSINA
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FLEETWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1514
Mailing Address - Country:US
Mailing Address - Phone:516-491-1859
Mailing Address - Fax:
Practice Address - Street 1:12 FLEETWOOD AVE
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1514
Practice Address - Country:US
Practice Address - Phone:516-491-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist