Provider Demographics
NPI:1720187388
Name:LEDGERWOOD, DAWN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:LEDGERWOOD
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 1:6607 BERRYTREE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6061
Mailing Address - Country:US
Mailing Address - Phone:281-343-1214
Mailing Address - Fax:
Practice Address - Street 1:4545 BISSONNET ST STE 215
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3114
Practice Address - Country:US
Practice Address - Phone:713-770-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17838235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7088315OtherAETNA
TX87879TOtherBLUE CROSS BLUE SHIELD