Provider Demographics
NPI:1265603138
Name:SADEWITZ, VICKI LYNN (MS)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:SADEWITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801
Mailing Address - Country:US
Mailing Address - Phone:973-366-6667
Mailing Address - Fax:937-366-3393
Practice Address - Street 1:77 UNION ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801
Practice Address - Country:US
Practice Address - Phone:973-366-6667
Practice Address - Fax:937-366-3397
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00008300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00008300OtherNJ STATE LICENSE