Provider Demographics
NPI:1255796579
Name:BUDY, VANESSA (MA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BUDY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11430 51ST AVE NW
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-7897
Mailing Address - Country:US
Mailing Address - Phone:253-857-6500
Mailing Address - Fax:253-857-2225
Practice Address - Street 1:11430 51ST AVE NW
Practice Address - Street 2:SUITE 101A
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-7897
Practice Address - Country:US
Practice Address - Phone:253-857-6500
Practice Address - Fax:253-857-2225
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60586943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist