Provider Demographics
NPI:1467010462
Name:SLOUGH, NICOLE WILSON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:WILSON
Last Name:SLOUGH
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 1:1510 JOHN ED CIR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3462
Mailing Address - Country:US
Mailing Address - Phone:501-733-9673
Mailing Address - Fax:
Practice Address - Street 1:2220 PRINCE ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3750
Practice Address - Country:US
Practice Address - Phone:501-450-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist