Provider Demographics
NPI:1467840090
Name:NICKISCH, BRETT KIMBERLY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BRETT
Middle Name:KIMBERLY
Last Name:NICKISCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 NE 79TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1564
Mailing Address - Country:US
Mailing Address - Phone:816-797-5415
Mailing Address - Fax:
Practice Address - Street 1:724 NE 79TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-1564
Practice Address - Country:US
Practice Address - Phone:816-797-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist