Provider Demographics
NPI:1538281795
Name:MUNDY, NATALIE CAROL
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:CAROL
Last Name:MUNDY
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 1:112 ALTON ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-4421
Mailing Address - Country:US
Mailing Address - Phone:863-420-2189
Mailing Address - Fax:
Practice Address - Street 1:409 S 10TH ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-5603
Practice Address - Country:US
Practice Address - Phone:863-422-8656
Practice Address - Fax:863-422-4379
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist