Provider Demographics
NPI:1376782540
Name:NIKOLAEV, RUSLANA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:RUSLANA
Middle Name:
Last Name:NIKOLAEV
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:RUSLANA
Other - Middle Name:
Other - Last Name:KHOSID AGARUNOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 WILLOWMORE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2342
Mailing Address - Country:US
Mailing Address - Phone:347-237-6492
Mailing Address - Fax:
Practice Address - Street 1:400 LOBO LN
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5218
Practice Address - Country:US
Practice Address - Phone:347-237-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018758235Z00000X
TX116530235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist