Provider Demographics
NPI:1669921417
Name:HIGGINS, NICOLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 PHOENIX RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-1274
Mailing Address - Country:US
Mailing Address - Phone:417-766-1703
Mailing Address - Fax:
Practice Address - Street 1:244 PHOENIX RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-1274
Practice Address - Country:US
Practice Address - Phone:417-766-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist