MEDICARE: MR. SIDNEY JOSEPH BADEAUX MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801068509	MI

General Provider Information

NPI Number	:	1073610317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIDNEY JOSEPH BADEAUX MSW

Provider Business Mailing Address
First Line	:	45 BERNEY WAY DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-9112
Country	:	US
Telephone Number	:	501-257-2311
Fax Number	:	501-257-2308

Provider Business Practice Location Address
First Line	:	2220 FT. ROOTS DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114
Country	:	US
Telephone Number	:	501-257-2311
Fax Number	:	501-257-2308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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