Provider Demographics
NPI:1659621431
Name:NERSES, BRIDGET JEAN DEVANEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:JEAN DEVANEY
Last Name:NERSES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2305
Mailing Address - Country:US
Mailing Address - Phone:516-742-5243
Mailing Address - Fax:
Practice Address - Street 1:129 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2305
Practice Address - Country:US
Practice Address - Phone:516-742-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1390508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist