Provider Demographics
NPI:1801221957
Name:SEGARS, NICOLLE (MCD)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:
Last Name:SEGARS
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4160
Mailing Address - Country:US
Mailing Address - Phone:803-773-5796
Mailing Address - Fax:
Practice Address - Street 1:26 WILLOW DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4160
Practice Address - Country:US
Practice Address - Phone:803-773-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist