Provider Demographics
NPI:1043394331
Name:BASTEAN, JUDITH ANN (MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:BASTEAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4499 COUNTY ROAD 351
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-5147
Mailing Address - Country:US
Mailing Address - Phone:573-642-0337
Mailing Address - Fax:573-592-0711
Practice Address - Street 1:850 WEST HOSPITAL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-5147
Practice Address - Country:US
Practice Address - Phone:573-592-0337
Practice Address - Fax:573-592-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01159231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist