=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538596549
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLA STONE SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2013
-----------------------------------------------------
Last Update Date | 10/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 COTTONWOOD ST
-----------------------------------------------------
City | BRENHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77833-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-836-3434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7240 ROE AVE
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66208-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-935-4541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 108287
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1066
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------