MEDICARE: NICOLE KATHERINE PRINZ

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	118510	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285361956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE KATHERINE PRINZ

Provider Business Mailing Address
First Line	:	215 NE 14TH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-8901
Country	:	US
Telephone Number	:	817-814-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 DENVER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-9011
Country	:	US
Telephone Number	:	817-814-2600
Fax Number	:

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

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	01/09/2026

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Directions to “ NICOLE KATHERINE PRINZ ” Practice Location

Language	Start Address	Practice Location

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