Provider Demographics
NPI:1851419485
Name:NICHOLS, JOY WALTZ (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:WALTZ
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 REDBUD TREE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-6253
Mailing Address - Country:US
Mailing Address - Phone:919-244-5996
Mailing Address - Fax:
Practice Address - Street 1:2338 REDBUD TREE DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-6253
Practice Address - Country:US
Practice Address - Phone:919-244-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007735235Z00000X
NC8686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413240Medicaid
PA1011096800001OtherMEDICAL ASSISTANCE #