Provider Demographics
NPI:1114045713
Name:BACHNIVSKY, VALENTINA (MAT)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:BACHNIVSKY
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-0106
Mailing Address - Country:US
Mailing Address - Phone:765-664-3470
Mailing Address - Fax:765-664-3489
Practice Address - Street 1:915 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2505
Practice Address - Country:US
Practice Address - Phone:765-664-3470
Practice Address - Fax:765-664-3489
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23000855A231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100417580AMedicaid
IN295210OtherMEDICARE
IN000000188598OtherBLUE CROSS AUDIOLOGY