| Doctor Name: | MRS. DOMINIQUE S. NELSON |
| NPI Number: | 1407223704 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CCC-SLP |
| License Number: | SA12741 |
| Business Practice Address: | 3117 Lithia Pinecrest Rd Valrico, FL - 335965632 |
| Business Phone Number: | 8136621106 |
| Business Fax Number: | 8136617661 |
| Mailing Address: | 8520 White Poplar Dr, RIVERVIEW |
| State: | FL |
| Postal Code: | 335788636 |
| Phone Number: | 8136588106 |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2015 |
| NPI Last Update Date: | 08/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA12741 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| 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 |