Provider Demographics
NPI:1639371842
Name:BRIDGES, PEGGY LYNN (BS, CRADC)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:LYNN
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:BS, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 JONES ST
Mailing Address - Street 2:PO BOX 470
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3824
Mailing Address - Country:US
Mailing Address - Phone:573-888-6545
Mailing Address - Fax:573-888-2369
Practice Address - Street 1:1109 JONES ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3824
Practice Address - Country:US
Practice Address - Phone:573-888-6545
Practice Address - Fax:573-888-2369
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2938101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507496OtherHEALTHLINK PPO
MO162252OtherBLUE CHOICE
MO162252OtherBLUE CROSS AND BLUE SHIEL