Provider Demographics
NPI:1568006096
Name:MCKNIGHT, BRIDGET DENISE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:DENISE
Last Name:MCKNIGHT
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 1:5959 FOREST TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-6535
Mailing Address - Country:US
Mailing Address - Phone:630-248-4683
Mailing Address - Fax:
Practice Address - Street 1:5959 FOREST TRAIL DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-6535
Practice Address - Country:US
Practice Address - Phone:630-248-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical