Individual
REBECCA BRIDGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 E JEFFERSON ST, BOISE, ID 83712-6231
(208) 381-5000
(208) 381-5005
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY-203727
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/06/2020
Last updated
08/25/2023
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