Healthcare Provider Details

I. General information

NPI: 1104318260
Provider Name (Legal Business Name): REBECCA LYNN BUDNICK AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN BUDNICK AU.D.

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223-8355
US

IV. Provider business mailing address

650 JOEL DR
FORT CAMPBELL KY
42223-8355
US

V. Phone/Fax

Practice location:
  • Phone: 281-900-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80967
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: