Provider Demographics
NPI:1710152566
Name:BUDZINSKI, HENRY R
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:R
Last Name:BUDZINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 COUNTY HIGHWAY J
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3388
Mailing Address - Country:US
Mailing Address - Phone:715-723-8805
Mailing Address - Fax:
Practice Address - Street 1:4905 COUNTY HIGHWAY J
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3388
Practice Address - Country:US
Practice Address - Phone:715-723-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI579237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42812200Medicaid