Provider Demographics
NPI:1669120614
Name:DEBRUYNE, NICOLE RYANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RYANN
Last Name:DEBRUYNE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RYANN
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:260 SUMMIT BLVD APT 8204
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8337
Mailing Address - Country:US
Mailing Address - Phone:951-813-8402
Mailing Address - Fax:
Practice Address - Street 1:260 SUMMIT BLVD APT 8204
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8337
Practice Address - Country:US
Practice Address - Phone:951-813-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist