Provider Demographics
NPI:1801486774
Name:NELSON, TRYCE R
Entity type:Individual
Prefix:
First Name:TRYCE
Middle Name:R
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 CHERRY ST APT 2SOUTH
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3111
Mailing Address - Country:US
Mailing Address - Phone:515-494-8127
Mailing Address - Fax:
Practice Address - Street 1:2908 CHERRY ST APT 2SOUTH
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-3111
Practice Address - Country:US
Practice Address - Phone:515-494-8127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020010344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist