Provider Demographics
NPI:1871825679
Name:ALLEN, NICOLE DEMARS (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DEMARS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:H
Other - Last Name:DEMARS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLPA
Mailing Address - Street 1:701 W WETMORE RD RM 168
Mailing Address - Street 2:PIMA COUNTY AMPHITHEATER SCHOOLS DBA AMPHITHEATER PUBLI
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5237
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 W WETMORE RD RM 168
Practice Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5237
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6397235Z00000X
AZSLPA6397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ495766Medicaid