Provider Demographics
NPI:1609484575
Name:WHICKER, NATALIE NIELSEN (MS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:NIELSEN
Last Name:WHICKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ELISE
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1442 N CORMORANT PL APT 205
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-7982
Mailing Address - Country:US
Mailing Address - Phone:480-772-8051
Mailing Address - Fax:
Practice Address - Street 1:13075 W PERSIMMON LN STE 120
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1986
Practice Address - Country:US
Practice Address - Phone:208-793-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-4362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist