Provider Demographics
NPI:1821605577
Name:BOTZUM, HENRY (AUD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:BOTZUM
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:BOTZUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4124
Mailing Address - Country:US
Mailing Address - Phone:413-224-2225
Mailing Address - Fax:
Practice Address - Street 1:510 NORTH ST STE 6
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5493
Practice Address - Country:US
Practice Address - Phone:413-224-2225
Practice Address - Fax:413-346-6798
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4827-SP-AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist