Provider Demographics
NPI:1801420757
Name:BRYDEN, CAROLYN JANE (MAT)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JANE
Last Name:BRYDEN
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:381 S HAYWARD AVE
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-2257
Mailing Address - Country:US
Mailing Address - Phone:208-724-3917
Mailing Address - Fax:
Practice Address - Street 1:381 S HAYWARD AVE
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-2257
Practice Address - Country:US
Practice Address - Phone:208-724-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician