Provider Demographics
NPI:1336539451
Name:BRIDGMAN, TERRIE
Entity Type:Individual
Prefix:DR
First Name:TERRIE
Middle Name:
Last Name:BRIDGMAN
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 1:1232 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1622
Mailing Address - Country:US
Mailing Address - Phone:847-251-8168
Mailing Address - Fax:
Practice Address - Street 1:1232 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1622
Practice Address - Country:US
Practice Address - Phone:847-251-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist