Provider Demographics
NPI:1750503579
Name:NICHOLAS, GRETA JANE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:JANE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:2727 MC CLELLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1626
Mailing Address - Country:US
Mailing Address - Phone:417-659-6493
Mailing Address - Fax:417-625-2097
Practice Address - Street 1:2727 MC CLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1626
Practice Address - Country:US
Practice Address - Phone:417-659-6493
Practice Address - Fax:417-625-2097
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO112580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist