Provider Demographics
NPI:1992146351
Name:FOLEY, BRIDGET COLLEEN (SLP)
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:COLLEEN
Last Name:FOLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:BRIDGET
Other - Middle Name:COLLEEN
Other - Last Name:POLICICCHIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1629 POST RD APT 305
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7331
Mailing Address - Country:US
Mailing Address - Phone:713-298-5575
Mailing Address - Fax:
Practice Address - Street 1:2200 S LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4567
Practice Address - Country:US
Practice Address - Phone:512-219-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist