Provider Demographics
NPI:1699377044
Name:TRIPP, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TRIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 NORTH LOOP W STE 160
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8001
Mailing Address - Country:US
Mailing Address - Phone:832-831-0043
Mailing Address - Fax:832-200-2266
Practice Address - Street 1:2180 NORTH LOOP W STE 160
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8001
Practice Address - Country:US
Practice Address - Phone:832-831-0043
Practice Address - Fax:832-200-2266
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01395168OtherTEXAS DRIVER'S LICENSE