Provider Demographics
NPI:1528681533
Name:PETERSON, BRIDGET (MS/CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS/CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:GALLIONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/CCC-SLP, TSSLD
Mailing Address - Street 1:410 SIERRA VISTA LANE
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989
Mailing Address - Country:US
Mailing Address - Phone:845-570-0416
Mailing Address - Fax:
Practice Address - Street 1:664 ORANGEBURG ROAD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965
Practice Address - Country:US
Practice Address - Phone:845-735-3066
Practice Address - Fax:845-735-8243
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY031191235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program