Provider Demographics
NPI:1144968991
Name:DUKE, CONSTANCE NICHOL (MS,CCC/SLP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:NICHOL
Last Name:DUKE
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NICKNAME
Mailing Address - Street 1:133 FAIRFIELD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9235
Mailing Address - Country:US
Mailing Address - Phone:985-516-2488
Mailing Address - Fax:
Practice Address - Street 1:133 FAIRFIELD OAKS DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9235
Practice Address - Country:US
Practice Address - Phone:985-516-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist