Provider Demographics
NPI:1639429012
Name:BZDELL, ANTONIEA PAULINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANTONIEA
Middle Name:PAULINE
Last Name:BZDELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 N HILTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1734
Mailing Address - Country:US
Mailing Address - Phone:208-321-4898
Mailing Address - Fax:208-321-4859
Practice Address - Street 1:1650 N HILTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1734
Practice Address - Country:US
Practice Address - Phone:208-321-4898
Practice Address - Fax:208-321-4859
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist