Provider Demographics
NPI:1720015738
Name:HACKER, NICOLE L (AUD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:HACKER
Suffix:
Gender:F
Credentials:AUD, PHD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:STOTTLEMYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 W WACKERLY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-7367
Mailing Address - Country:US
Mailing Address - Phone:989-486-1457
Mailing Address - Fax:
Practice Address - Street 1:112 W WACKERLY ST STE 1
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7367
Practice Address - Country:US
Practice Address - Phone:989-486-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01462231H00000X
MI1601000579231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist