Provider Demographics
NPI:1053588145
Name:BRIDGEMAN, SUZANNE LYNETTE (SLP ASSISTANT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LYNETTE
Last Name:BRIDGEMAN
Suffix:
Gender:F
Credentials:SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 CORONA DR
Mailing Address - Street 2:SUITE 234
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4324
Mailing Address - Country:US
Mailing Address - Phone:361-854-1110
Mailing Address - Fax:361-854-7910
Practice Address - Street 1:4444 CORONA DR
Practice Address - Street 2:SUITE 234
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4324
Practice Address - Country:US
Practice Address - Phone:361-854-1110
Practice Address - Fax:361-854-7910
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164704201Medicaid