Provider Demographics
NPI:1053552695
Name:SEDGWICK, NATALIE SUZZANN (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUZZANN
Last Name:SEDGWICK
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S CARROLL BLVD
Mailing Address - Street 2:#207
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-7415
Mailing Address - Country:US
Mailing Address - Phone:469-296-8337
Mailing Address - Fax:972-947-3975
Practice Address - Street 1:525 S CARROLL BLVD
Practice Address - Street 2:#207
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-7415
Practice Address - Country:US
Practice Address - Phone:469-296-8337
Practice Address - Fax:972-947-3975
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200429303OtherMEDICAID CSHCN
TX200429301Medicaid