Provider Demographics
NPI:1457798076
Name:VALE, BRIDGETTE L (SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:L
Last Name:VALE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:L
Other - Last Name:KRANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:872 W DAYTON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1503
Practice Address - Country:US
Practice Address - Phone:309-344-3400
Practice Address - Fax:309-344-3401
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist