Provider Demographics
NPI:1669484226
Name:DEWALD, NATASHA L (AUD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:L
Last Name:DEWALD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 CRICOLI DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2133
Mailing Address - Country:US
Mailing Address - Phone:760-219-4228
Mailing Address - Fax:
Practice Address - Street 1:5701 W SLAUGHTER LN
Practice Address - Street 2:STE A130-227
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-6527
Practice Address - Country:US
Practice Address - Phone:512-956-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1795237600000X
TX80721237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05363ZMedicare UPIN