Provider Demographics
NPI:1992900302
Name:BRIDGER, KAREN COLEY (MA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:COLEY
Last Name:BRIDGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:COLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:101 MARGARET LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4207
Mailing Address - Country:US
Mailing Address - Phone:530-272-2247
Mailing Address - Fax:530-272-4120
Practice Address - Street 1:101 MARGARET LN
Practice Address - Street 2:SUITE D
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4207
Practice Address - Country:US
Practice Address - Phone:530-272-2247
Practice Address - Fax:530-272-4120
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU305237600000X
CAHA979237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0010700Medicaid