Provider Demographics
NPI:1184136327
Name:BLEVINS, BRIDGETT DENISE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETT
Middle Name:DENISE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 8
Mailing Address - Street 2:RUSSELL COUNTY PUBLIC SCHOOLS
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-889-6500
Mailing Address - Fax:276-889-6508
Practice Address - Street 1:84 LORRAINE C. TURNER DRIVE
Practice Address - Street 2:RUSSELL COUNTY PUBLIC SCHOOLS
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-889-6500
Practice Address - Fax:276-889-6508
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist