Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1114509908 |
---|---|
Provider Name | Lauren N Bridgewater |
First Address | Shawnee, OK 74801-7067 |
Second Address | Shawnee, OK 74801-7067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2021 |
Last Update Date | 22/04/2021 |