Provider Demographics
NPI:1881104479
Name:HUDGENS, BRIDGET ASHLEY (RBT)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ASHLEY
Last Name:HUDGENS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:ASHLEY
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10181 TIMBER WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2014
Mailing Address - Country:US
Mailing Address - Phone:702-596-8674
Mailing Address - Fax:
Practice Address - Street 1:408 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2658
Practice Address - Country:US
Practice Address - Phone:702-502-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-17-41676106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician