NPI | 1124560933 |
---|---|
Former Name | NICOLE CELESTE REYNOLDS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: OK 5495) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TN 6075) |
Enumeration Date | 2016-11-09 |
Last Update Date | 2021-08-05 |