Provider Demographics
NPI:1467078071
Name:BRIDGES, JUDITH T (SPEECH, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:T
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:SPEECH, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 MOSLEY DR
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-7511
Mailing Address - Country:US
Mailing Address - Phone:318-413-0873
Mailing Address - Fax:
Practice Address - Street 1:204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2717
Practice Address - Country:US
Practice Address - Phone:318-628-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1031OtherSPEECH LANGUAGE PATHOLOGY