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General NPI Number Information
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NPI Number | 1407368400
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Entity Type | Individual
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Provider Name | NICOLE BANDA MHS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 1165 FIRECRACKER
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City | BUDA
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State | TX
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Zip | 78610-1208
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Country | US
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Telephone | 573-803-7634
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Fax |
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Provider Business Mailing Address
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Address Line | 705 FRANCIS DR
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City | JACKSON
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State | MO
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Zip | 63755-1325
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Country | US
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Telephone | 573-803-7634
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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 | 2017030476
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License Number State | MO
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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 | 119065
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License Number State | TX
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