Provider Demographics
NPI:1124752795
Name:RIVAS, NICOLE MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:MARIE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 INGRAM RD APT 2306
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1030
Mailing Address - Country:US
Mailing Address - Phone:956-784-5620
Mailing Address - Fax:
Practice Address - Street 1:225 E SONTERRA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3993
Practice Address - Country:US
Practice Address - Phone:210-495-9944
Practice Address - Fax:210-495-2540
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist