Individual
SHANNON ALYSE NIKULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP-A
Contact information
Practice address
21168 E TIERRA GRANDE DR, QUEEN CREEK, AZ 85142-6767
(702) 817-3160
Mailing address
21168 E TIERRA GRANDE DR, QUEEN CREEK, AZ 85142-6767
(702) 817-3160
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA11256
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D10928623
ARIZONA DRIVER'S LICENSE
AZ
Enumeration date
02/26/2019
Last updated
02/26/2019
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