Provider Demographics
NPI:1093982142
Name:TUCKER, NANCY H (MA/CCC, SLP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:H
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MA/CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FOREST DR NE
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690-9703
Mailing Address - Country:US
Mailing Address - Phone:828-874-8861
Mailing Address - Fax:828-874-3056
Practice Address - Street 1:210 FOREST DR NE
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-9703
Practice Address - Country:US
Practice Address - Phone:828-874-8861
Practice Address - Fax:828-874-3056
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411729Medicaid