Provider Demographics
NPI:1639496870
Name:NELSON, EUDORA TECUMSEH (MS)
Entity Type:Individual
Prefix:
First Name:EUDORA
Middle Name:TECUMSEH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:EUDORA
Other - Middle Name:
Other - Last Name:PICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:38620 DESERT MIRAGE DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-0606
Mailing Address - Country:US
Mailing Address - Phone:760-776-0060
Mailing Address - Fax:
Practice Address - Street 1:38620 DESERT MIRAGE DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-0606
Practice Address - Country:US
Practice Address - Phone:760-776-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist