Organization
BRIDGEWAY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM NELSON (CEO)
(309) 344-2323
Entity
Organization
Contact information
Practice address
310 WYLIE DR, SUITE 464, NORMAL, IL 61761-5504
(309) 452-2797
(309) 452-9811
Mailing address
310 WYLIE DR, SUITE 464, NORMAL, IL 61761-5504
(309) 452-2797
(309) 452-9811
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
04016
IL
101YM0800X
Mental Health Counselor
04016
IL
101YP2500X
Professional Counselor
04016
IL
104100000X
Social Worker
04016
IL
251S00000X
Community/Behavioral Health Agency
04016
IL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04016
—
IL
01
—
AC 217/557-9285
MEDICARE CERTIFICATION
IL
Enumeration date
10/03/2011
Last updated
08/19/2019
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us