Provider Demographics
NPI:1932601846
Name:PARKER, NICOLE T (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:T
Last Name:PARKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 W 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-7400
Mailing Address - Country:US
Mailing Address - Phone:773-627-4326
Mailing Address - Fax:
Practice Address - Street 1:9160 W 106TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-7400
Practice Address - Country:US
Practice Address - Phone:773-627-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007126A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist