Provider Demographics
NPI:1144837550
Name:CLIMPSON, NYESHA CHARMAINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NYESHA
Middle Name:CHARMAINE
Last Name:CLIMPSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4837
Mailing Address - Country:US
Mailing Address - Phone:678-278-9244
Mailing Address - Fax:
Practice Address - Street 1:490 S PERRY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4837
Practice Address - Country:US
Practice Address - Phone:678-278-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012805235Z00000X
COSLP.0005792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist