Provider Demographics
NPI:1629360367
Name:FETTERMAN, BRIDGET MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:FETTERMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W EARLE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5562
Mailing Address - Country:US
Mailing Address - Phone:219-221-2271
Mailing Address - Fax:
Practice Address - Street 1:29 N ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2629
Practice Address - Country:US
Practice Address - Phone:864-331-1400
Practice Address - Fax:864-331-1416
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist