Provider Demographics
NPI:1033347208
Name:OWENS, NICOLE LAVOIE (SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAVOIE
Last Name:OWENS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 S. STAPLES STREET
Mailing Address - Street 2:SUITE 400 & 500
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4646
Mailing Address - Country:US
Mailing Address - Phone:361-855-1352
Mailing Address - Fax:361-855-1254
Practice Address - Street 1:5633 S. STAPLES STREET
Practice Address - Street 2:SUITE 400 & 500
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4646
Practice Address - Country:US
Practice Address - Phone:361-855-1352
Practice Address - Fax:361-855-1254
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207118501Medicaid