Provider Demographics
NPI:1871914671
Name:BRIDENBAUGH, JANINE GULLICK (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:GULLICK
Last Name:BRIDENBAUGH
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HUNTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1923
Mailing Address - Country:US
Mailing Address - Phone:618-277-2100
Mailing Address - Fax:
Practice Address - Street 1:125 HUNTWOOD RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1923
Practice Address - Country:US
Practice Address - Phone:618-277-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist