Provider Demographics
NPI:1639581572
Name:EASON, BRIDGET ANGELA
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANGELA
Last Name:EASON
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 1:723 BOOJUM CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2642
Mailing Address - Country:US
Mailing Address - Phone:313-404-0331
Mailing Address - Fax:
Practice Address - Street 1:723 BOOJUM CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-2642
Practice Address - Country:US
Practice Address - Phone:313-404-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst