Provider Demographics
NPI:1689702839
Name:SEEDORF, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SEEDORF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 S BEND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-5640
Mailing Address - Country:US
Mailing Address - Phone:574-272-2245
Mailing Address - Fax:574-272-8559
Practice Address - Street 1:2130 S BEND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-5640
Practice Address - Country:US
Practice Address - Phone:574-272-2245
Practice Address - Fax:574-272-8559
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001128A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist