Provider Demographics
NPI:1194805259
Name:SEDLAK, GINNIE D (MA, CCC)
Entity type:Individual
Prefix:
First Name:GINNIE
Middle Name:D
Last Name:SEDLAK
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3183 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4910
Mailing Address - Country:US
Mailing Address - Phone:336-760-9925
Mailing Address - Fax:
Practice Address - Street 1:1308 WESTGATE CENTER DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2933
Practice Address - Country:US
Practice Address - Phone:336-768-7946
Practice Address - Fax:336-768-7969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist