Healthcare Provider Details

I. General information

NPI: 1013194786
Provider Name (Legal Business Name): CAROL A. BUDZENSKI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 N DEFIANCE ST
STRYKER OH
43557-9472
US

IV. Provider business mailing address

PO BOX 197
WATERVILLE OH
43566-0197
US

V. Phone/Fax

Practice location:
  • Phone: 419-682-1011
  • Fax: 419-682-6097
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3855
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: