Provider Demographics
NPI:1962666586
Name:BODDORF, DANA J (AUD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:BODDORF
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-2305
Mailing Address - Country:US
Mailing Address - Phone:814-769-0840
Mailing Address - Fax:
Practice Address - Street 1:233 EASTERLY PKWY
Practice Address - Street 2:STE 102
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6300
Practice Address - Country:US
Practice Address - Phone:814-867-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-13
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT-000990-L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00658036Medicare PIN
PA130685XMPMedicare PIN