Healthcare Provider Details

I. General information

NPI: 1275234247
Provider Name (Legal Business Name): ICON SPEECH & LANGUAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 LAKESIDE DR
RENO NV
89509-3409
US

IV. Provider business mailing address

500 W PLUMB LN STE B173
RENO NV
89509-3796
US

V. Phone/Fax

Practice location:
  • Phone: 775-233-5773
  • Fax:
Mailing address:
  • Phone: 775-464-1281
  • Fax: 775-464-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE MURPHY
Title or Position: OWNER
Credential: M.S., CCC-SLP
Phone: 775-233-5773