Provider Demographics
NPI:1629353750
Name:SERA-BUDNEY & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SERA-BUDNEY & ASSOCIATES, LLC
Other - Org Name:PARKSIDE AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SERA-BUDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:719-650-5672
Mailing Address - Street 1:6085 GAMBLER PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1143
Mailing Address - Country:US
Mailing Address - Phone:719-650-5672
Mailing Address - Fax:
Practice Address - Street 1:175 S UNION BLVD STE 330
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3143
Practice Address - Country:US
Practice Address - Phone:719-650-5672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01220080Medicaid