Provider Demographics
NPI:1124509005
Name:SEWELL, NATALIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:SEWELL
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 1:5511 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5621
Mailing Address - Country:US
Mailing Address - Phone:469-714-5225
Mailing Address - Fax:
Practice Address - Street 1:310 S JUPITER RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3039
Practice Address - Country:US
Practice Address - Phone:972-727-5850
Practice Address - Fax:972-727-5625
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110522OtherSPEECH-LANGUAGE PATHOLOGY STATE LICENSE
TX12138620OtherASHA