Healthcare Provider Details

I. General information

NPI: 1518750959
Provider Name (Legal Business Name): NIKKI NICOLE HUTCHINSON CCC-SLP, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21721 SE 71ST AVE
HAWTHORNE FL
32640-3976
US

IV. Provider business mailing address

21721 SE 71ST AVE
HAWTHORNE FL
32640-3976
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-0332
  • Fax:
Mailing address:
  • Phone: 352-234-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14525671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: