Provider Demographics
NPI:1992974497
Name:BRIDGER CHILD & ADOLESCENT PSYCHIATRY
Entity type:Organization
Organization Name:BRIDGER CHILD & ADOLESCENT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KROGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-586-9735
Mailing Address - Street 1:931 HIGHLAND BLVD
Mailing Address - Street 2:STE. 3340
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6911
Mailing Address - Country:US
Mailing Address - Phone:406-586-9735
Mailing Address - Fax:406-586-4713
Practice Address - Street 1:931 HIGHLAND BLVD
Practice Address - Street 2:STE. 3340
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6911
Practice Address - Country:US
Practice Address - Phone:406-586-9735
Practice Address - Fax:406-586-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8323302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization