Provider Demographics
NPI:1457637134
Name:HUNTER, NICOLE K
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:HUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 NE 109TH AVE.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2534
Mailing Address - Country:US
Mailing Address - Phone:503-701-9115
Mailing Address - Fax:
Practice Address - Street 1:1023 6TH AVE SW
Practice Address - Street 2:ATTN: REHAB DEPT (SPEECH THERAPY)
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1917
Practice Address - Country:US
Practice Address - Phone:503-701-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13565235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38107Medicare PIN