Provider Demographics
NPI:1962638098
Name:ANDERSEN-DUNN, BRIDGETTE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGETTE
Middle Name:MARIE
Last Name:ANDERSEN-DUNN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:
Practice Address - Street 1:124 E SHORT AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1555
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:509-363-2762
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2021-03-04
Deactivation Date:2011-10-12
Deactivation Code:
Reactivation Date:2012-08-24
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WAPY60970308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist