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General NPI Number Information
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NPI Number | 1427407352
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Entity Type | Individual
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Provider Name | TAMARA BIDSTRUP CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 101 E ROMANA ST APT 406
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City | PENSACOLA
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State | FL
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Zip | 32502-5861
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Country | US
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Telephone | 850-428-0665
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Fax | 877-215-4951
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Provider Business Mailing Address
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Address Line | 101 E ROMANA ST APT 406
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City | PENSACOLA
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State | FL
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Zip | 32502-5861
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Country | US
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Telephone | 850-428-0665
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Fax | 877-215-4951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SZ7554
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA16050
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License Number State | FL
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