Provider Demographics
NPI:1770210809
Name:WALDRON, NATASHA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N55W33304 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-9747
Mailing Address - Country:US
Mailing Address - Phone:262-617-8860
Mailing Address - Fax:
Practice Address - Street 1:N55W33304 TERRACE DR
Practice Address - Street 2:
Practice Address - City:NASHOTAH
Practice Address - State:WI
Practice Address - Zip Code:53058-9747
Practice Address - Country:US
Practice Address - Phone:262-617-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14149552OtherASHA CCC