Provider Demographics
NPI:1902162274
Name:DENNY, NICOLE DEANNE (MA, CCC-SLP, L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DEANNE
Last Name:DENNY
Suffix:
Gender:F
Credentials:MA, CCC-SLP, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173303 W 193 PR SW
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-8547
Mailing Address - Country:US
Mailing Address - Phone:509-786-1136
Mailing Address - Fax:
Practice Address - Street 1:326 CHARDONNAY BLVD
Practice Address - Street 2:PROSSER PHYSICAL THERAPY AND REHAB
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350
Practice Address - Country:US
Practice Address - Phone:509-786-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60274749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist