Provider Demographics
NPI:1629111406
Name:ALCORN, BRIDGETT A (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:BRIDGETT
Middle Name:A
Last Name:ALCORN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:DR
Other - First Name:BRIDGETT
Other - Middle Name:A
Other - Last Name:GIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:1733 TEAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-7003
Mailing Address - Country:US
Mailing Address - Phone:317-362-5990
Mailing Address - Fax:
Practice Address - Street 1:1733 TEAKWOOD LN
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-7003
Practice Address - Country:US
Practice Address - Phone:317-362-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01766231H00000X
IN23002409A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist