Provider Demographics
NPI:1699321745
Name:OURADNIK, STEVE R
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:R
Last Name:OURADNIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 W KENNEWICK AVE APT D326
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2883
Mailing Address - Country:US
Mailing Address - Phone:509-952-7501
Mailing Address - Fax:
Practice Address - Street 1:3703 W KENNEWICK AVE APT D326
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2883
Practice Address - Country:US
Practice Address - Phone:509-952-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60202575101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60202575Medicaid