Provider Demographics
NPI:1043695612
Name:PRINCE, NICOLE JACQUELINE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JACQUELINE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 N EXPRESSWAY # 77
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-1422
Mailing Address - Country:US
Mailing Address - Phone:956-443-0266
Mailing Address - Fax:956-443-0292
Practice Address - Street 1:814 N EXPRESSWAY # 77
Practice Address - Street 2:SUITE 5
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-1422
Practice Address - Country:US
Practice Address - Phone:956-443-0266
Practice Address - Fax:956-443-0292
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist