MEDICARE: MRS. DANIELLE NICHOLE NELSON 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	3331	KS

General Provider Information

NPI Number	:	1639423122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE NICHOLE NELSON MS CCC-SLP

Provider Business Mailing Address
First Line	:	10000 W 75TH ST STE 250
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-2218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 W 75TH ST STE 250
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-2218
Country	:	US
Telephone Number	:	888-913-1174
Fax Number	:

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

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	04/05/2013

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