Basic Information
| Provider Information | |||||||||
| NPI: | 1720503634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REDMON | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | KATHERINE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1675 SW MARLOW AVE STE 303 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972255102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037095137 | ||||||||
| FaxNumber: | 8332735779 | ||||||||
| Practice Location | |||||||||
| Address1: | 1014 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986603151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606951014 | ||||||||
| FaxNumber: | 3607501374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L8414 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.