Provider Demographics
NPI:1598996845
Name:SEWELL, GREGORY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SEWELL
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 LARKHALL AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1512
Mailing Address - Country:US
Mailing Address - Phone:626-840-6139
Mailing Address - Fax:
Practice Address - Street 1:531 LARKHALL AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1512
Practice Address - Country:US
Practice Address - Phone:626-840-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 9462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist