Provider Demographics
NPI:1932691144
Name:SIPOLE, NATALIE RAE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RAE
Last Name:SIPOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-7513
Mailing Address - Country:US
Mailing Address - Phone:618-541-6922
Mailing Address - Fax:
Practice Address - Street 1:7211 LEBANON RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-7513
Practice Address - Country:US
Practice Address - Phone:618-541-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty