Provider Demographics
NPI:1326285909
Name:DEPREZ, NICOLE LEE RAE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEE RAE
Last Name:DEPREZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 N 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2488
Mailing Address - Country:US
Mailing Address - Phone:402-431-0854
Mailing Address - Fax:
Practice Address - Street 1:4313 N 157TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2488
Practice Address - Country:US
Practice Address - Phone:402-431-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist