Provider Demographics
NPI:1033167523
Name:BADURIA, BERNARD (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:BADURIA
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S J ST FL 5
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-627-6731
Mailing Address - Fax:253-942-2279
Practice Address - Street 1:1608 S J ST FL 5
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-627-6731
Practice Address - Fax:253-942-2279
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002604231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0208423OtherSTATE L&I
WA0226989OtherSTATE L&I
WA0208421OtherSTATE L&I
WA8452740Medicaid
WA8941429OtherSTATE CRIME VICTIMS
WAG8860211Medicare PIN
WAG8860198Medicare PIN