Provider Demographics
NPI:1487438511
Name:SUPAN, NATASHA ADELE
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:ADELE
Last Name:SUPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 FULTON AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5141
Mailing Address - Country:US
Mailing Address - Phone:916-531-6135
Mailing Address - Fax:
Practice Address - Street 1:1325 HOWE AVE STE 207
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3364
Practice Address - Country:US
Practice Address - Phone:707-344-1771
Practice Address - Fax:707-773-7318
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant