Provider Demographics
NPI:1184282675
Name:WALSH, NIKKI LEIGH (MEDCCC-SLP)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEIGH
Last Name:WALSH
Suffix:
Gender:F
Credentials:MEDCCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MEDCCC-SLP
Mailing Address - Street 1:6500 BAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-9012
Mailing Address - Country:US
Mailing Address - Phone:918-914-0008
Mailing Address - Fax:
Practice Address - Street 1:117 W 5TH ST # LL
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6651
Practice Address - Country:US
Practice Address - Phone:918-203-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist