Provider Demographics
NPI:1013436765
Name:BRIDGWATER, CHRISTEN (BCPP)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:
Last Name:BRIDGWATER
Suffix:
Gender:F
Credentials:BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 APPLE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6324
Mailing Address - Country:US
Mailing Address - Phone:909-680-5102
Mailing Address - Fax:
Practice Address - Street 1:312 APPLE RIVER DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6324
Practice Address - Country:US
Practice Address - Phone:909-680-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2150059405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional