Provider Demographics
NPI:1487813796
Name:BRIDGES, DIAN RENEE (BCBA, MA)
Entity Type:Individual
Prefix:MISS
First Name:DIAN
Middle Name:RENEE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:BCBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BROADWELL CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2667
Mailing Address - Country:US
Mailing Address - Phone:615-778-9101
Mailing Address - Fax:615-778-9185
Practice Address - Street 1:175 BROADWELL CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2667
Practice Address - Country:US
Practice Address - Phone:615-778-9101
Practice Address - Fax:615-778-9185
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-02-0896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00828OtherDMRS