Provider Demographics
NPI:1194207753
Name:HUMPHRIES, NICHOLE (SLPA)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 S US HIGHWAY 287
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109-8960
Mailing Address - Country:US
Mailing Address - Phone:903-874-6315
Mailing Address - Fax:
Practice Address - Street 1:3728 S US HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-8960
Practice Address - Country:US
Practice Address - Phone:903-874-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX402002355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant