Provider Demographics
NPI:1326304627
Name:MEDFORD-LADD, NICOLE (SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MEDFORD-LADD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7361 PRAIRIE FALCON RD
Mailing Address - Street 2:STE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0823
Mailing Address - Country:US
Mailing Address - Phone:702-804-1511
Mailing Address - Fax:702-804-2551
Practice Address - Street 1:7361 PRAIRIE FALCON RD
Practice Address - Street 2:STE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0823
Practice Address - Country:US
Practice Address - Phone:702-804-1511
Practice Address - Fax:702-804-2551
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist