Provider Demographics
NPI:1629061668
Name:DODGEN, NIKKI (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:
Last Name:DODGEN
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:PO BOX 3250
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3250
Mailing Address - Country:US
Mailing Address - Phone:806-358-8974
Mailing Address - Fax:806-359-0506
Practice Address - Street 1:2505 LAKEVIEW DR
Practice Address - Street 2:SUITE 302
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1527
Practice Address - Country:US
Practice Address - Phone:806-358-8974
Practice Address - Fax:806-359-0506
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist