Provider Demographics
NPI:1942557111
Name:REYNA, NICOLLE LEA (SLP)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:LEA
Last Name:REYNA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 HUEBNER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1342
Mailing Address - Country:US
Mailing Address - Phone:210-691-0039
Mailing Address - Fax:210-699-0136
Practice Address - Street 1:9910 HUEBNER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1342
Practice Address - Country:US
Practice Address - Phone:210-691-0039
Practice Address - Fax:210-699-0136
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist