Provider Demographics
NPI:1164835567
Name:DENISE, NANCY W (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:W
Last Name:DENISE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9281
Mailing Address - Country:US
Mailing Address - Phone:937-778-0469
Mailing Address - Fax:
Practice Address - Street 1:2000 W STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2572
Practice Address - Country:US
Practice Address - Phone:937-339-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist