Provider Demographics
NPI:1508088055
Name:NICHOLSON, NANNETTE (PHD)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 S UNIVERSITY AVE - UALR
Mailing Address - Street 2:SUITE 600 UNIVERSITY PLAZA
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1000
Mailing Address - Country:US
Mailing Address - Phone:501-569-8909
Mailing Address - Fax:501-569-3157
Practice Address - Street 1:2801 S UNIVERSITY AVE - UALR
Practice Address - Street 2:SUITE 600 UNIVERSITY PLAZA
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1000
Practice Address - Country:US
Practice Address - Phone:501-569-8909
Practice Address - Fax:501-569-3157
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR255231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170942720Medicaid