Provider Demographics
NPI:1861546913
Name:BEAUDOIN, STACEY ELIZABETH (AUD)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ELIZABETH
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:E
Other - Last Name:STRUNKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1135 116TH AVE NE SUITE 500
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-454-3938
Mailing Address - Fax:425-454-2568
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 500
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-3938
Practice Address - Fax:425-454-2568
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00004422231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA65043UOtherREGENCE BLUESHIELD
WA8476038Medicaid
WA0218801OtherLABOR & INDUSTRY
WA0218801OtherLABOR & INDUSTRY