Provider Demographics
NPI:1639143282
Name:NIXON, CONSTANCE NICOLE (MED CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:NICOLE
Last Name:NIXON
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Gender:F
Credentials:MED CCC/SLP
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Mailing Address - Street 1:4080 MCGINNIS FERRY RD
Mailing Address - Street 2:BUILDING 300, SUITE 302
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3948
Mailing Address - Country:US
Mailing Address - Phone:978-992-1935
Mailing Address - Fax:770-410-9510
Practice Address - Street 1:4080 MCGINNIS FERRY RD
Practice Address - Street 2:BUILDING 300, SUITE 302
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3948
Practice Address - Country:US
Practice Address - Phone:978-992-1935
Practice Address - Fax:770-410-9510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GASLP005930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist