Individual
HEATHER RUTH NICHOLLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
191 BRUCE AVE, SHREVEPORT, LA 71105-3712
(318) 218-1339
Mailing address
191 BRUCE AVE, SHREVEPORT, LA 71105-3712
(318) 218-1339
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6459
LA
Other
Enumeration date
04/28/2015
Last updated
04/28/2015
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