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NPI Code Detail

MEDICARE: NICOLE R LEE M.S. CCC-SLP

MEDICARE: NICOLE R LEE M.S. CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist1465NV
2235Z00000XSpeech-Language Pathologist4044-154WI

General Provider Information

NPI Number : 1194075580
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE R LEE M.S. CCC-SLP
Provider Business Mailing Address
First Line : 3030 S JONES BLVD
Second Line : SUITE 105
City : LAS VEGAS
State : NV
Zip : 89146-6792
Country : US
Telephone Number : 702-360-1137
Fax Number :
Provider Business Practice Location Address
First Line : 725 BUTLER AVE
Second Line :
City : OSHKOSH
State : WI
Zip : 54901-8149
Country : US
Telephone Number : 920-237-6396
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2012
Last Update Date : 01/21/2016

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