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Organization
BRIDGEWAY INC
Active
Organization
BRIDGEWAY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACI DANNER MBA (CEO)
(309) 836-4108
Entity
Organization
Contact information
Practice address
2323 WINDISH DR, GALESBURG, IL 61401-9780
(309) 344-4200
(309) 344-4281
Mailing address
2323 WINDISH DR, GALESBURG, IL 61401-9780
(309) 344-2323
(309) 344-4368
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
IL
207Q00000X
Family Medicine Physician
—
IL
2084P0800X
Psychiatry Physician
—
IL
2084P0804X
Child & Adolescent Psychiatry Physician
—
IL
251S00000X
Community/Behavioral Health Agency
—
IL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001180005
CERTIFIC/LICENSE
IL
Enumeration date
07/27/2006
Last updated
12/26/2025
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