Provider Demographics
NPI:1740407717
Name:REARDON, NICHOLE MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:MARIE
Last Name:REARDON
Suffix:
Gender:F
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 1:4600 38TH ST
Mailing Address - Street 2:COLUMBUS COMMUNITY HOSPITAL
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1664
Mailing Address - Country:US
Mailing Address - Phone:402-562-3341
Mailing Address - Fax:402-564-0730
Practice Address - Street 1:4600 38TH ST
Practice Address - Street 2:COLUMBUS COMMUNITY HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1664
Practice Address - Country:US
Practice Address - Phone:402-562-3341
Practice Address - Fax:402-564-0730
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist