| Organization Name: | BRIDGEWAY INC |
| NPI Number: | 1861776213 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STACI DANNER (BILLING MANAGER) |
| Mailing Address: | 590 S Deer Rd Macomb |
| State: | IL US |
| Postal Code: | 614552604 |
| Phone Number: | 3098374876 |
| Fax Number: | 3098331531 |
| NPI Enumeration Date: | 10/04/2011 |
| NPI Last Update Date: | 11/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 04016 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |