Provider Demographics
NPI:1861012122
Name:BRIDGES, AYLA BETH (MS)
Entity Type:Individual
Prefix:
First Name:AYLA
Middle Name:BETH
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AYLA
Other - Middle Name:BETH
Other - Last Name:UFFENHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:613 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4104
Mailing Address - Country:US
Mailing Address - Phone:707-545-4600
Mailing Address - Fax:
Practice Address - Street 1:613 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4104
Practice Address - Country:US
Practice Address - Phone:707-545-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117144106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist