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NPI Code Detail

MEDICARE: MS. KORI LEE SEDGLEY LCSW

MEDICARE: MS. KORI LEE SEDGLEY LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker7058FL

General Provider Information

NPI Number : 1942350442
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KORI LEE SEDGLEY LCSW
Provider Business Mailing Address
First Line : 2354 UNIVERSITY BLVD N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-3228
Country : US
Telephone Number : 904-421-6058
Fax Number : 904-744-8131
Provider Business Practice Location Address
First Line : 2354 UNIVERSITY BLVD N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-3228
Country : US
Telephone Number : 904-421-6058
Fax Number : 904-744-8131
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 07/08/2007

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