Provider Demographics
NPI:1871844068
Name:MATTSON, NICOLE L (MS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:MATTSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MABERLY ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1560
Mailing Address - Country:US
Mailing Address - Phone:308-991-8262
Mailing Address - Fax:
Practice Address - Street 1:412 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1213
Practice Address - Country:US
Practice Address - Phone:308-995-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist