Provider Demographics
NPI:1205587474
Name:TURNER, NICOLE R (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:TURNER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 GENERAL PATTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70615-6937
Mailing Address - Country:US
Mailing Address - Phone:337-302-5858
Mailing Address - Fax:
Practice Address - Street 1:2913 GENERAL PATTON ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-6937
Practice Address - Country:US
Practice Address - Phone:337-302-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist