Provider Demographics
NPI:1518594019
Name:DRUST, BRIDGET (SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:DRUST
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:MILESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:570-842-9362
Mailing Address - Fax:570-842-9362
Practice Address - Street 1:542 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1750
Practice Address - Country:US
Practice Address - Phone:570-489-5010
Practice Address - Fax:570-489-5060
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL012256OtherDEPARTMENT OF STATE
PASL012256OtherSTATE PROFESSIONAL LICENSE