Healthcare Provider Details

I. General information

NPI: 1649105644
Provider Name (Legal Business Name): NICOLE M WINEBERG M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 W CANFIELD AVE
COEUR D ALENE ID
83815-9764
US

IV. Provider business mailing address

10 E PINERIDGE CT APT 5B
SPOKANE WA
99208-7013
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-3502
  • Fax:
Mailing address:
  • Phone: 509-850-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5581317
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: