Provider Demographics
NPI:1932763133
Name:IDEKER, BRIDGET (LICSW)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:IDEKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2091
Mailing Address - Country:US
Mailing Address - Phone:253-565-4484
Mailing Address - Fax:253-565-5823
Practice Address - Street 1:6316 S 12TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1900
Practice Address - Country:US
Practice Address - Phone:235-565-4887
Practice Address - Fax:253-565-2983
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609054651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical