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NPI Code Detail

MEDICARE: NICOLE NIEL MCCORRISTON M.ED., CCC-SLP

MEDICARE: NICOLE NIEL MCCORRISTON M.ED., 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 PathologistSP-3864NV

General Provider Information

NPI Number : 1275393555
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE NIEL MCCORRISTON M.ED., CCC-SLP
Provider Business Mailing Address
First Line : 10575 ALONDRA PEAK ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-4651
Country : US
Telephone Number : 323-646-4843
Fax Number :
Provider Business Practice Location Address
First Line : 9121 W RUSSELL RD STE 117
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1238
Country : US
Telephone Number : 702-499-6638
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2024
Last Update Date : 05/12/2024

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Directions to “ NICOLE NIEL MCCORRISTON M.ED., CCC-SLP” Practice Location

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