Provider Demographics
NPI:1013173079
Name:PICOU, ALICIA MIGNON (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MIGNON
Last Name:PICOU
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:PICOU
Other - Last Name:BOUNDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:130 E MCIVER ST
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-7667
Mailing Address - Country:US
Mailing Address - Phone:919-639-2635
Mailing Address - Fax:919-639-9583
Practice Address - Street 1:130 E MCIVER ST
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-7667
Practice Address - Country:US
Practice Address - Phone:919-639-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NC8183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist