Provider Demographics
NPI:1205408184
Name:CARMENATE-NICHOLS, RAIZA (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:CARMENATE-NICHOLS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:RAIZA
Other - Middle Name:
Other - Last Name:CARMENATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-0804
Mailing Address - Country:US
Mailing Address - Phone:813-545-9100
Mailing Address - Fax:
Practice Address - Street 1:728 S JEFFERSON AVE STE 8
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4279
Practice Address - Country:US
Practice Address - Phone:931-854-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist