Provider Demographics
NPI:1700958709
Name:WADSWORTH, STEVEN D
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 E SPRUCE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3379
Mailing Address - Country:US
Mailing Address - Phone:559-431-6700
Mailing Address - Fax:559-431-6777
Practice Address - Street 1:1243 E SPRUCE AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3379
Practice Address - Country:US
Practice Address - Phone:559-431-6700
Practice Address - Fax:559-431-6777
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP489235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist