Provider Demographics
NPI:1285344309
Name:BADILLO, BERNARD FAUSTOS LABRADOR (MA)
Entity type:Individual
Prefix:
First Name:BERNARD FAUSTOS
Middle Name:LABRADOR
Last Name:BADILLO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:BERNIE
Other - Middle Name:
Other - Last Name:BADILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:612 JEMISON GRV APT 308
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-3684
Mailing Address - Country:US
Mailing Address - Phone:719-639-0270
Mailing Address - Fax:
Practice Address - Street 1:612 JEMISON GRV APT 308
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-3684
Practice Address - Country:US
Practice Address - Phone:719-639-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0005122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist