Individual
KELLY ANN BRIDGEFORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9221 E BASELINE RD STE 109, MESA, AZ 85209-8314
(805) 325-1421
(480) 895-9889
Mailing address
2730 S VALLE VERDE, MESA, AZ 85209-7886
(805) 325-1421
(480) 895-9889
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-000349
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AZ
Enumeration date
06/07/2018
Last updated
06/07/2018
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