Provider Demographics
NPI:1104969831
Name:GOODWIN, BRIDGETTE JEANNE
Entity type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:JEANNE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRIDGETTE
Other - Middle Name:JEANNE
Other - Last Name:BARNHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2706 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2118
Mailing Address - Country:US
Mailing Address - Phone:314-773-4493
Mailing Address - Fax:
Practice Address - Street 1:1082 OLD DES PERES RD
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1865
Practice Address - Country:US
Practice Address - Phone:314-821-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist