Provider Demographics
NPI:1720884653
Name:BRIDGEMAN, EMILY (EDS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BRIDGEMAN
Suffix:
Gender:
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 SAINT GASPAR DR W
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-7361
Mailing Address - Country:US
Mailing Address - Phone:219-866-8549
Mailing Address - Fax:
Practice Address - Street 1:1389 SAINT GASPAR DR W
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-7361
Practice Address - Country:US
Practice Address - Phone:219-866-8549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN000016857103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool