Provider Demographics
NPI:1942350442
Name:SEDGLEY, KORI LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KORI
Middle Name:LEE
Last Name:SEDGLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KORI
Other - Middle Name:LEE
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2354 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3228
Mailing Address - Country:US
Mailing Address - Phone:904-421-6058
Mailing Address - Fax:904-744-8131
Practice Address - Street 1:2354 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3228
Practice Address - Country:US
Practice Address - Phone:904-421-6058
Practice Address - Fax:904-744-8131
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical