Provider Demographics
NPI:1649857863
Name:BORTNICK, BRIDGET
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BORTNICK
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 1:15383 S GRAVES RD
Mailing Address - Street 2:
Mailing Address - City:MULINO
Mailing Address - State:OR
Mailing Address - Zip Code:97042-9789
Mailing Address - Country:US
Mailing Address - Phone:360-727-1450
Mailing Address - Fax:
Practice Address - Street 1:15383 S GRAVES RD
Practice Address - Street 2:
Practice Address - City:MULINO
Practice Address - State:OR
Practice Address - Zip Code:97042-9789
Practice Address - Country:US
Practice Address - Phone:360-727-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor