Provider Demographics
NPI:1750956124
Name:DEVILBISS, NICOLE J (CCC-A)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:J
Last Name:DEVILBISS
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 W 9000 S STE 311
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4775
Mailing Address - Country:US
Mailing Address - Phone:801-566-8304
Mailing Address - Fax:
Practice Address - Street 1:3584 W 9000 S STE 311
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4775
Practice Address - Country:US
Practice Address - Phone:801-566-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12312856-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist