Individual
DENISE R NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3336
(573) 785-6707
(573) 785-0336
Mailing address
1110 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3336
(573) 785-6707
(573) 785-0336
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
100435
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100435
SPEECH LANG PATH CERT
MO
Enumeration date
11/28/2006
Last updated
07/08/2007
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