Provider Demographics
NPI:1891329900
Name:KLEITSCH, BRIDGET ELIZABETH
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELIZABETH
Last Name:KLEITSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:ELIZABETH
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7371 244TH ST
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:IA
Mailing Address - Zip Code:52033-8624
Mailing Address - Country:US
Mailing Address - Phone:563-451-4108
Mailing Address - Fax:
Practice Address - Street 1:106 1/2 MAQUOKETA ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1461
Practice Address - Country:US
Practice Address - Phone:563-451-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA098984OtherLMHC
IA098984OtherTLMHC LICENSE