Provider Information for 1932763133
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BRIDGET IDEKER LICSW
Sex: Female
NPI: 1932763133
Last Updated: 2019-04-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
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| NPI | 1932763133 | ||||||||||||||
| Enumeration Date | 2019-04-24 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 6424 N 9TH ST TACOMA, WA 98406-2091 United States Phone: 253-565-4484 | Fax:253-565-5823 | ||||||||||||||
| Primary Practice Address | 6316 S 12TH ST TACOMA, WA 98465-1900 United States Phone: 235-565-4887 | Fax:253-565-2983 | ||||||||||||||
| Secondary Practice Address(es) | 6424 N 9TH ST | ||||||||||||||
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