Provider Demographics
NPI:1518630318
Name:MCFADDEN, BRIDGET NICOLE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:NICOLE
Last Name:MCFADDEN
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 1:1464 HILLCREST AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3762
Mailing Address - Country:US
Mailing Address - Phone:234-738-9583
Mailing Address - Fax:
Practice Address - Street 1:1464 HILLCREST AVE APT 8
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3762
Practice Address - Country:US
Practice Address - Phone:234-738-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health