Provider Demographics
NPI:1194251124
Name:BUSSJAEGER, BRIDGET OLIVIA
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:OLIVIA
Last Name:BUSSJAEGER
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 1:2977 COLLIER AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7563
Mailing Address - Country:US
Mailing Address - Phone:901-605-3293
Mailing Address - Fax:
Practice Address - Street 1:1010 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-1902
Practice Address - Country:US
Practice Address - Phone:904-478-8395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor