Provider Demographics
NPI:1427520022
Name:WALTER, BRIDGETTE JASPER (RBT)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:JASPER
Last Name:WALTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:JASPER
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2312 DURWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-3431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2312 DURWOOD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-3431
Practice Address - Country:US
Practice Address - Phone:501-313-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRBT-18-62850106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR902566664OtherSPECIALTY