Provider Demographics
NPI:1376957167
Name:BIDWELL, CAROLYN L (MA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:BIDWELL
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 1:11576 RISCOS HILL RD
Mailing Address - Street 2:HC 33 BOX 2772
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89161-1106
Mailing Address - Country:US
Mailing Address - Phone:303-345-3460
Mailing Address - Fax:
Practice Address - Street 1:61 N WILLOW ST
Practice Address - Street 2:STE #4
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4785
Practice Address - Country:US
Practice Address - Phone:702-346-4696
Practice Address - Fax:702-346-4699
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor