Provider Demographics
NPI:1073054243
Name:SERGOTICK, THERESA CAMPEGGIO (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:CAMPEGGIO
Last Name:SERGOTICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:CLAIRE
Other - Last Name:CAMPEGGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:19801 N CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19801 N CREEK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8240
Practice Address - Country:US
Practice Address - Phone:425-984-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist