Provider Demographics
NPI:1407225741
Name:CWENGROS, BRIDGET C (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:C
Last Name:CWENGROS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:C
Other - Last Name:FOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2101 WOODDALE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-738-9888
Mailing Address - Fax:651-738-9889
Practice Address - Street 1:2101 WOODDALE DR
Practice Address - Street 2:SUITE A
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4441
Practice Address - Country:US
Practice Address - Phone:651-738-9888
Practice Address - Fax:651-738-9889
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist