Doctor Name: | ASHLEY NICKELL |
NPI Number: | 1295006781 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 3778 |
Business Practice Address: | 2102 S Santa Fe Ave Apt. 104 Moore, OK - 731602823 |
Business Phone Number: | 4055173606 |
Business Fax Number: | |
Mailing Address: | 2102 S Santa Fe Ave, Apt. 104 MOORE |
State: | OK |
Postal Code: | 731602823 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/16/2012 |
NPI Last Update Date: | 01/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3778 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |