Basic Information
| Provider Information | |||||||||
| NPI: | 1861967325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDRIDGE | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | BA, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 821 FITCHLAND DR | ||||||||
| Address2: | |||||||||
| City: | VANDALIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453771325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374325906 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3095 KETTERING BLVD | ||||||||
| Address2: | |||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372938300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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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 | 104100000X | S.1802568 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.