Provider Demographics
NPI:1710273438
Name:OURSO, NIKKI ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:ANN
Last Name:OURSO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 BROADWAY ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-3509
Mailing Address - Country:US
Mailing Address - Phone:917-583-9135
Mailing Address - Fax:
Practice Address - Street 1:213 BROADWAY ST APT B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-3509
Practice Address - Country:US
Practice Address - Phone:917-583-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist