Provider Demographics
NPI:1538564257
Name:ARCHAMBAULT BESSON, NICOLE MARIE (EDS, MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:ARCHAMBAULT BESSON
Suffix:
Gender:F
Credentials:EDS, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 6TH ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1650
Mailing Address - Country:US
Mailing Address - Phone:310-936-3020
Mailing Address - Fax:
Practice Address - Street 1:1218 6TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1650
Practice Address - Country:US
Practice Address - Phone:310-936-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist