Provider Demographics
NPI:1952000747
Name:WILLIAMS, BRIDGETTE
Entity Type:Individual
Prefix:MISS
First Name:BRIDGETTE
Middle Name:
Last Name:WILLIAMS
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 1:204 GRAND ISLE CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-2200
Mailing Address - Country:US
Mailing Address - Phone:504-443-5997
Mailing Address - Fax:
Practice Address - Street 1:204 GRAND ISLE CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-2200
Practice Address - Country:US
Practice Address - Phone:504-443-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA437373400Medicaid