Provider Demographics
NPI:1265560288
Name:BRIDGEWATER SPEECH & HEARING, INC
Entity type:Organization
Organization Name:BRIDGEWATER SPEECH & HEARING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BAERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:865-769-0283
Mailing Address - Street 1:103 SUBURBAN RD
Mailing Address - Street 2:SUITE 101D
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5586
Mailing Address - Country:US
Mailing Address - Phone:865-769-0283
Mailing Address - Fax:
Practice Address - Street 1:103 SUBURBAN RD
Practice Address - Street 2:SUITE 101D
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5586
Practice Address - Country:US
Practice Address - Phone:865-769-0283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0142231H00000X
TN1278235Z00000X
TN2154235Z00000X
TN0275231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730962Medicaid