Individual
MISS KATHERINE E BRIDGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
634 N MAIN ST STE 4, O FALLON, IL 62269-3746
(618) 726-5870
Mailing address
6 CAMPUS EDGE DR APT 108, EDWARDSVILLE, IL 62025-4004
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
IL
Other
Enumeration date
06/04/2019
Last updated
06/04/2019
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