Provider Demographics
NPI:1396910113
Name:NICHOLSON, DEBORAH DELEE (MS)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:DELEE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 PARK PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-5516
Mailing Address - Country:US
Mailing Address - Phone:409-985-2529
Mailing Address - Fax:409-985-3565
Practice Address - Street 1:2935 PARK PLAZA LN
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5516
Practice Address - Country:US
Practice Address - Phone:409-985-2529
Practice Address - Fax:409-985-3565
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50489231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112785401Medicaid
TX00Z944Medicare PIN
TXC13165Medicare UPIN