Provider Demographics
NPI:1194876011
Name:BUKOWSKI, GENE W (AUD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:W
Last Name:BUKOWSKI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S. 24TH ST. W. #7
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-656-2003
Mailing Address - Fax:406-656-2003
Practice Address - Street 1:111 S 24TH ST W UNIT 7
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5659
Practice Address - Country:US
Practice Address - Phone:406-656-2003
Practice Address - Fax:406-656-2003
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT252231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0530491Medicaid