Provider Demographics
NPI:1477278042
Name:SEEDORF, CAROLINE MARGARET (CLINICAL REHAB CRED)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:MARGARET
Last Name:SEEDORF
Suffix:
Gender:F
Credentials:CLINICAL REHAB CRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 KUPFER DR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-5048
Mailing Address - Country:US
Mailing Address - Phone:951-719-6882
Mailing Address - Fax:
Practice Address - Street 1:1200 E ACACIA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4504
Practice Address - Country:US
Practice Address - Phone:951-765-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist