Provider Demographics
NPI:1255936415
Name:BADGEROW, RANDALL LEE
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:BADGEROW
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 1:613 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-8529
Mailing Address - Country:US
Mailing Address - Phone:989-316-5235
Mailing Address - Fax:
Practice Address - Street 1:3400 S WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-4958
Practice Address - Country:US
Practice Address - Phone:989-755-1072
Practice Address - Fax:989-755-1401
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)