Provider Demographics
NPI:1467226415
Name:BRIDGEMAN, CIAIRA K
Entity Type:Individual
Prefix:
First Name:CIAIRA
Middle Name:K
Last Name:BRIDGEMAN
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 1:16016 BRATTON LN UNIT 5203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-3015
Mailing Address - Country:US
Mailing Address - Phone:512-294-8397
Mailing Address - Fax:
Practice Address - Street 1:1205 SAM BASS RD BLDG B
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4247
Practice Address - Country:US
Practice Address - Phone:512-807-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician