Provider Demographics
NPI:1760822399
Name:BADSTUBNER, AMY CHRISTINE (AUD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CHRISTINE
Last Name:BADSTUBNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 N KIMBALL AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6883
Mailing Address - Country:US
Mailing Address - Phone:817-421-3277
Mailing Address - Fax:817-380-3256
Practice Address - Street 1:578 N KIMBALL AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6883
Practice Address - Country:US
Practice Address - Phone:817-778-4934
Practice Address - Fax:817-380-3256
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80477237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362901OtherMEDICARE
TX362902ZH8SOtherMEDICARE