Basic Information
| Provider Information | |||||||||
| NPI: | 1780209502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | BRIDGET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 W 4TH ST STE 10 | ||||||||
| Address2: | |||||||||
| City: | FOSTORIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448301864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194368320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 455 W 4TH ST STE 10 | ||||||||
| Address2: | |||||||||
| City: | FOSTORIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448301864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194368320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2020 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | COND.20201358-SPW | OH | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP.14331 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.