Provider Demographics
NPI:1659122034
Name:HESS, NICHOLAS RAY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RAY
Last Name:HESS
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-3938
Mailing Address - Country:US
Mailing Address - Phone:918-413-6452
Mailing Address - Fax:
Practice Address - Street 1:TUSKAHOMA RD & CO RD 1652
Practice Address - Street 2:
Practice Address - City:TUSKAHOMA
Practice Address - State:OK
Practice Address - Zip Code:74574
Practice Address - Country:US
Practice Address - Phone:918-569-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist