Provider Demographics
NPI:1215521273
Name:BRIDGES, EMMA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 OLD LANESVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-7919
Mailing Address - Country:US
Mailing Address - Phone:812-972-9314
Mailing Address - Fax:
Practice Address - Street 1:6850 OLD LANESVILLE RD NE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-7919
Practice Address - Country:US
Practice Address - Phone:812-972-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst