Healthcare Provider Details

I. General information

NPI: 1215108592
Provider Name (Legal Business Name): SUSAN KAY SEDWICK L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 DOUGLAS AVE SUITE 390
DALLAS TX
75225-5923
US

IV. Provider business mailing address

7008 SPRING CREEK TRL
WATAUGA TX
76148-2174
US

V. Phone/Fax

Practice location:
  • Phone: 214-234-2400
  • Fax: 214-234-2401
Mailing address:
  • Phone: 817-627-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: