Provider Demographics
NPI:1558720003
Name:SLUDER, NORMA JEAN (MACCC/SLP)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:JEAN
Last Name:SLUDER
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:JEAN
Other - Last Name:MANGRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 HOMESTEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-5462
Mailing Address - Country:US
Mailing Address - Phone:423-715-2732
Mailing Address - Fax:
Practice Address - Street 1:537 SPRING ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3232
Practice Address - Country:US
Practice Address - Phone:931-232-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist