Provider Demographics
NPI:1770635070
Name:KOUDELKA, BARBARA L (NMD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:L
Last Name:KOUDELKA
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41977 W BACCARAT DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3949
Mailing Address - Country:US
Mailing Address - Phone:602-463-6823
Mailing Address - Fax:
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 209
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8978
Practice Address - Country:US
Practice Address - Phone:602-855-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-790175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath