Provider Demographics
NPI:1992361539
Name:BRIDGES, REBECCA BYRD
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BYRD
Last Name:BRIDGES
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 1:419 EMMITT BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-6037
Mailing Address - Country:US
Mailing Address - Phone:601-382-5780
Mailing Address - Fax:
Practice Address - Street 1:419 EMMITT BROWN RD
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-6037
Practice Address - Country:US
Practice Address - Phone:601-382-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2020-01-27
Deactivation Date:2019-05-23
Deactivation Code:
Reactivation Date:2019-12-27
Provider Licenses
StateLicense IDTaxonomies
MSS3883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist