Provider Demographics
NPI:1649355009
Name:BETTENCOURT, NICOLE PATRICIA (AUD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PATRICIA
Last Name:BETTENCOURT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DREYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:194 PLEASANT ST
Mailing Address - Street 2:STE 2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2952
Mailing Address - Country:US
Mailing Address - Phone:603-224-2353
Mailing Address - Fax:
Practice Address - Street 1:194 PLEASANT ST STE 2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-224-2353
Practice Address - Fax:603-226-0727
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA348231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7309692Y0NH01OtherANTHEM BCBS
NH616251OtherHARVARD PILGRIM HP
NH14191OtherCIGNA
NH30009420Medicaid
NH616251OtherHARVARD PILGRIM HP
NH14191OtherCIGNA