Provider Demographics
NPI:1124442256
Name:GARRISON, BRIDGET (AUD)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:NIEDERMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6565 NORTH CHARLES STREET
Mailing Address - Street 2:PPE SUITE 601
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-849-2142
Mailing Address - Fax:410-823-8309
Practice Address - Street 1:6565 NORTH CHARLES STREET
Practice Address - Street 2:PPN SUITE 250
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:410-823-8309
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01307231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist