Provider Demographics
NPI:1003138413
Name:NICHOLS, AMBER N (CCCSLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREENWOOD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4427
Mailing Address - Country:US
Mailing Address - Phone:501-625-7800
Mailing Address - Fax:501-325-2727
Practice Address - Street 1:100 GREENWOOD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4427
Practice Address - Country:US
Practice Address - Phone:501-625-7800
Practice Address - Fax:501-325-2727
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172997795Medicaid