MEDICARE: NIKOL L HANSON BOOTHE MS 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
1	235Z00000X	Speech-Language Pathologist	SLP1740	AZ

General Provider Information

NPI Number	:	1225294085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOL L HANSON BOOTHE MS CCC-SLP

Provider Business Mailing Address
First Line	:	3919 E WALLER LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4914
Country	:	US
Telephone Number	:	480-584-3923
Fax Number	:

Provider Business Practice Location Address
First Line	:	15640 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-3512
Country	:	US
Telephone Number	:	602-439-3800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	07/31/2008

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Directions to “ NIKOL L HANSON BOOTHE MS CCC-SLP” Practice Location

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