MEDICARE: NIKKI HUTTINGER MS CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SP 21915	CA
2	235Z00000X	Speech-Language Pathologist	2000172088	MO

General Provider Information

NPI Number	:	1144623257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI HUTTINGER MS CCC-SLP

Provider Business Mailing Address
First Line	:	3980 9TH AVE STE 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 9TH AVE
Second Line	:	STE 1
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3244
Country	:	US
Telephone Number	:	619-618-9639
Fax Number	:	866-875-2620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/02/2014

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Directions to “ NIKKI HUTTINGER MS CCC-SLP” Practice Location

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