Provider Demographics
NPI:1629445614
Name:ROBERTS, NICOLE (MHSC)
Entity Type:Individual
Prefix:MR
First Name:NICOLE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PADDOCKS BLVD
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3507
Mailing Address - Country:US
Mailing Address - Phone:843-816-4413
Mailing Address - Fax:
Practice Address - Street 1:10 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-3673
Practice Address - Country:US
Practice Address - Phone:843-681-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist