Provider Demographics
NPI:1780927384
Name:NICKELL, BRIANNA STARR (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:STARR
Last Name:NICKELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:STARR
Other - Last Name:HENLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2109 CEDARWOOD DR
Mailing Address - Street 2:SUITE200
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2670
Mailing Address - Country:US
Mailing Address - Phone:563-263-0557
Mailing Address - Fax:563-263-0560
Practice Address - Street 1:2109 CEDARWOOD DR
Practice Address - Street 2:SUITE200
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2670
Practice Address - Country:US
Practice Address - Phone:563-263-0557
Practice Address - Fax:563-263-0560
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist