Provider Demographics
NPI:1720250962
Name:HICKMAN, BRIDGET BLOOM (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:BLOOM
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 HEARST ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1120
Mailing Address - Country:US
Mailing Address - Phone:504-779-0400
Mailing Address - Fax:
Practice Address - Street 1:4937 HEARST ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1120
Practice Address - Country:US
Practice Address - Phone:504-779-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist