Provider Demographics
NPI:1265778286
Name:BARDIN, BARBARA KAYE
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:KAYE
Last Name:BARDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 148TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8269
Mailing Address - Country:US
Mailing Address - Phone:425-357-9063
Mailing Address - Fax:
Practice Address - Street 1:9401 SHARON DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-2647
Practice Address - Country:US
Practice Address - Phone:425-366-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist