Provider Demographics
NPI:1700070414
Name:KALLO, NICOLE MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:KALLO
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:PO BOX 10340
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0340
Mailing Address - Country:US
Mailing Address - Phone:254-554-8100
Mailing Address - Fax:
Practice Address - Street 1:882 S FORT HOOD ST
Practice Address - Street 2:STE 1050
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7433
Practice Address - Country:US
Practice Address - Phone:254-554-8100
Practice Address - Fax:254-554-8142
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100873235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist