Provider Demographics
NPI:1396259917
Name:DUGGAN, BRIDGET (CCC/SLP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:DUGGAN
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 1:9912 S TRUMBULL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3457
Mailing Address - Country:US
Mailing Address - Phone:708-218-7450
Mailing Address - Fax:
Practice Address - Street 1:441 N LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1211
Practice Address - Country:US
Practice Address - Phone:708-757-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-007124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist