Individual
JESSAMYN NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
217 E BREMER AVE, WAVERLY, IA 50677-3435
(319) 352-4544
Mailing address
217 E BREMER AVE, WAVERLY, IA 50677-3435
(319) 352-4544
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
085663
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
665992
—
IA
Enumeration date
06/22/2021
Last updated
06/25/2021
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