Provider Demographics
NPI:1093331480
Name:GENRICH, NICOLE E (AUD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:GENRICH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:E
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 E 23RD ST # A
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 S 90TH ST STE 125
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2047
Practice Address - Country:US
Practice Address - Phone:402-594-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE394231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist