Provider Demographics
NPI:1619685740
Name:VERDUSCO, BIANCA ANTONIA
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:ANTONIA
Last Name:VERDUSCO
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 1:1004 COMMERCIAL AVE # 1084
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4117
Mailing Address - Country:US
Mailing Address - Phone:509-654-2549
Mailing Address - Fax:
Practice Address - Street 1:950 SE REGATTA DR UNIT 101
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5451
Practice Address - Country:US
Practice Address - Phone:360-679-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61042806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist