Provider Demographics
NPI:1679507610
Name:TALMORE, NICHELEI ANISSA (MA CCCA)
Entity Type:Individual
Prefix:MS
First Name:NICHELEI
Middle Name:ANISSA
Last Name:TALMORE
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 HIGHWAY 36 S
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-9610
Mailing Address - Country:US
Mailing Address - Phone:979-836-4511
Mailing Address - Fax:
Practice Address - Street 1:4001 HIGHWAY 36 S
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-9610
Practice Address - Country:US
Practice Address - Phone:979-836-4511
Practice Address - Fax:979-277-1865
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003741237600000X, 231H00000X
TX80613231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA64BCBPTOtherMEDICARE
GA809412356AMedicaid