Basic Information
| Provider Information | |||||||||
| NPI: | 1922567908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPRINGMIRE | ||||||||
| FirstName: | BRIDGET | ||||||||
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| Credential: | MA, PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6336 DAVANE CT | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605163055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305894521 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8311 ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | FOREST PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601302529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082094181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2019 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TF0200X | Y | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No ID Information.