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General NPI Number Information
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NPI Number | 1225207996
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Entity Type | Individual
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Provider Name | NICKOLE A HINES-STAPLES MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 1601 TRINITY ST
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City | AUSTIN
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State | TX
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Zip | 78712-1765
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Country | US
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Telephone | 512-495-5257
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Fax | 989-774-1891
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Provider Business Mailing Address
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Address Line | 1315 ROADRUNNER DR
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City | CEDAR PARK
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State | TX
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Zip | 78613-5105
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Country | US
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Telephone | 713-203-1412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101004319
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 103963
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License Number State | TX
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