Provider Demographics
NPI:1760615249
Name:CORDOVA, NATALIA ISABEL (SLP)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:ISABEL
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6428 CAPE CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7641
Mailing Address - Country:US
Mailing Address - Phone:919-247-4551
Mailing Address - Fax:919-932-3456
Practice Address - Street 1:7250 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:HURDLE MILLS
Practice Address - State:NC
Practice Address - Zip Code:27541-9325
Practice Address - Country:US
Practice Address - Phone:336-514-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist