Provider Demographics
NPI:1972145613
Name:KUECKER, NICOLE AMANDA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMANDA
Last Name:KUECKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:AMANDA
Other - Last Name:SCHANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:5464 410TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITTEMORE
Mailing Address - State:IA
Mailing Address - Zip Code:50598-8027
Mailing Address - Country:US
Mailing Address - Phone:712-298-4115
Mailing Address - Fax:
Practice Address - Street 1:412 W KENNEDY ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-3100
Practice Address - Country:US
Practice Address - Phone:515-295-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist