Individual
LISA NICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 W 6TH ST, YUMA, AZ 85364-2973
(928) 502-4399
Mailing address
450 W 6TH ST, YUMA, AZ 85364-2973
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA8559
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010920614
—
AZ
Enumeration date
09/16/2013
Last updated
09/16/2013
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