Provider Demographics
NPI:1326770553
Name:BIDWELL, JARETH ISAIAH (AUD)
Entity Type:Individual
Prefix:DR
First Name:JARETH
Middle Name:ISAIAH
Last Name:BIDWELL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3504
Mailing Address - Country:US
Mailing Address - Phone:915-471-1547
Mailing Address - Fax:
Practice Address - Street 1:2331 YORK RD STE 102
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2246
Practice Address - Country:US
Practice Address - Phone:410-816-9660
Practice Address - Fax:410-397-5209
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01606231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist