Provider Demographics
NPI:1922245547
Name:HAGARTY, BRIDGETTE
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:HAGARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 OFFICE PARK RD
Mailing Address - Street 2:STE 221
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2549
Mailing Address - Country:US
Mailing Address - Phone:515-954-7610
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD
Practice Address - Street 2:STE 221
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2549
Practice Address - Country:US
Practice Address - Phone:515-954-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082915103TC0700X
CT003300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical