Individual
REBECCA NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1432 E LEE HWY, LOUDON, TN 37774-6440
(865) 458-8900
Mailing address
1432 E LEE HWY, LOUDON, TN 37774-6440
(865) 458-8900
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP0000001177
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP0000001177
TN HEALTH LICENSE
TN
Enumeration date
12/02/2019
Last updated
12/02/2019
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