Provider Demographics
NPI:1508141250
Name:BRIDGES, ROBERTA LOUISE (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LOUISE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S BOYLE ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:KS
Mailing Address - Zip Code:66537-9492
Mailing Address - Country:US
Mailing Address - Phone:785-969-5789
Mailing Address - Fax:
Practice Address - Street 1:2950 SW WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5326
Practice Address - Country:US
Practice Address - Phone:785-220-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 3084104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker