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1306858592
NICHOLAS MACKENZIE BRIDGETT
CHAMPAIGN, IL
NPI
1306858592
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: IL 149010226)
Enumeration Date
2006-08-13
Last Update Date
2007-07-08
Business Address
Mr. NICHOLAS MACKENZIE BRIDGETT LCSW
1801 FOX DR
CHAMPAIGN, IL 61820-7236
Phone number: 217-417-6432
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Mailing Address
Mr. NICHOLAS MACKENZIE BRIDGETT LCSW
1801 FOX DR
CHAMPAIGN, IL 61820-7236
Phone number: 217-417-6432
Copy
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