Provider Demographics
NPI:1073177994
Name:BARDWELL, ABIGAIL JEAN
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JEAN
Last Name:BARDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13925 INTERURBAN AVE S STE 120
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5726
Mailing Address - Country:US
Mailing Address - Phone:948-009-6206
Mailing Address - Fax:
Practice Address - Street 1:13925 INTERURBAN AVE S STE 120
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-5726
Practice Address - Country:US
Practice Address - Phone:948-009-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist