Doctor Name: | JULIE M NICKELS |
NPI Number: | 1487854527 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | EDS, CCC/SLP |
License Number: | 3443 |
Business Practice Address: | 6057 W Andrew Johnson Hwy Ste 4 Talbott, TN - 378778676 |
Business Phone Number: | 4235869459 |
Business Fax Number: | 4235869549 |
Mailing Address: | 201 Rayford Cir, RUTLEDGE |
State: | TN |
Postal Code: | 378614957 |
Phone Number: | 8658283474 |
Fax Number: | |
NPI Enumeration Date: | 07/18/2007 |
NPI Last Update Date: | 07/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3443 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
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 |