Provider Demographics
NPI:1568801371
Name:NATTIEL, DOROTHY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:NATTIEL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17920 GULF BLVD APT 1405
Mailing Address - Street 2:
Mailing Address - City:REDINGTON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1153
Mailing Address - Country:US
Mailing Address - Phone:813-210-5670
Mailing Address - Fax:
Practice Address - Street 1:17920 GULF BLVD APT 1405
Practice Address - Street 2:
Practice Address - City:REDINGTON SHORES
Practice Address - State:FL
Practice Address - Zip Code:33708-1153
Practice Address - Country:US
Practice Address - Phone:813-210-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-156235Z00000X
CASP33123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist