Provider Demographics
NPI:1679835789
Name:BECKER, BRIDGETTE ASHLEY (CMT, CD, BFE)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:ASHLEY
Last Name:BECKER
Suffix:
Gender:F
Credentials:CMT, CD, BFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 W WALTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3566
Mailing Address - Country:US
Mailing Address - Phone:248-882-2015
Mailing Address - Fax:
Practice Address - Street 1:4624 W WALTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3566
Practice Address - Country:US
Practice Address - Phone:248-882-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program