Provider Demographics
NPI:1891993739
Name:POTTER, NANCY ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:222 CORNELL PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2930
Mailing Address - Country:US
Mailing Address - Phone:502-724-9131
Mailing Address - Fax:414-908-7123
Practice Address - Street 1:222 CORNELL PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2930
Practice Address - Country:US
Practice Address - Phone:502-724-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002746A235Z00000X
KY1631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist