Provider Demographics
NPI:1457819062
Name:MINARD, NATALIE NICOLE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICOLE
Last Name:MINARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16615 HOWARD MILLMAN LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3533
Mailing Address - Country:US
Mailing Address - Phone:302-841-3256
Mailing Address - Fax:
Practice Address - Street 1:11 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:DE
Practice Address - Zip Code:19962-9304
Practice Address - Country:US
Practice Address - Phone:302-697-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0000607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist