Provider Demographics
NPI:1902446065
Name:LEVY, BRIDGETTE (LPC-IT; AT-P)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:LPC-IT; AT-P
Other - Prefix:
Other - First Name:GETTE
Other - Middle Name:
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-IT; AT-P
Mailing Address - Street 1:130 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9702
Mailing Address - Country:US
Mailing Address - Phone:315-664-2200
Mailing Address - Fax:
Practice Address - Street 1:6333 ODANA RD STE 20
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1130
Practice Address - Country:US
Practice Address - Phone:608-270-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional