Provider Demographics
NPI:1790917177
Name:WALDEMAR, BRIDGETTE-MAY DELORES (DEDLMED,CCC/SLP)
Entity Type:Individual
Prefix:DR
First Name:BRIDGETTE-MAY
Middle Name:DELORES
Last Name:WALDEMAR
Suffix:
Gender:F
Credentials:DEDLMED,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14772 69TH DR N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1906
Mailing Address - Country:US
Mailing Address - Phone:561-656-2411
Mailing Address - Fax:561-828-5771
Practice Address - Street 1:14772 69TH DR N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-1906
Practice Address - Country:US
Practice Address - Phone:561-656-2411
Practice Address - Fax:561-828-5771
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001332100Medicaid