Provider Demographics
NPI:1356619118
Name:WEISENBACH, BRIDGETTE C (LPC)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:C
Last Name:WEISENBACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:C
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6683
Mailing Address - Country:US
Mailing Address - Phone:479-750-2020
Mailing Address - Fax:479-750-4843
Practice Address - Street 1:1200 W WALNUT ST
Practice Address - Street 2:STE 1400
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3521
Practice Address - Country:US
Practice Address - Phone:479-725-6000
Practice Address - Fax:479-750-4843
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1201003101YM0800X
101YM0800X
ARP1409065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health