Provider Demographics
NPI:1487263620
Name:MCCLURG, AUDREY SHERIDAN
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:SHERIDAN
Last Name:MCCLURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:SHERIDAN
Other - Last Name:WENZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4710 40TH AVE SW # N726
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4674
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3796 VEST MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2912
Practice Address - Country:US
Practice Address - Phone:336-837-4797
Practice Address - Fax:336-376-7711
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60993771235Z00000X
NC14319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist