Provider Demographics
NPI:1073036927
Name:BODZIAK, TARA (AUD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:BODZIAK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 SOUTHWESTERN BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1234
Mailing Address - Country:US
Mailing Address - Phone:716-674-4188
Mailing Address - Fax:716-674-4834
Practice Address - Street 1:3085 SOUTHWESTERN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1234
Practice Address - Country:US
Practice Address - Phone:716-674-4188
Practice Address - Fax:716-674-4834
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002745231H00000X
NY14000050439237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter