Provider Demographics
NPI:1831460013
Name:NELSON, BARBARA R (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RIDGE POINT CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-3445
Mailing Address - Country:US
Mailing Address - Phone:636-447-4466
Mailing Address - Fax:
Practice Address - Street 1:8 RIDGE POINT CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-3445
Practice Address - Country:US
Practice Address - Phone:636-447-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist