Provider Demographics
NPI:1194271494
Name:MILLER, BRIDGETTE (ECEEN, MS)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ECEEN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1202
Mailing Address - Country:US
Mailing Address - Phone:608-274-0355
Mailing Address - Fax:608-274-5546
Practice Address - Street 1:5534 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1202
Practice Address - Country:US
Practice Address - Phone:608-204-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health