Provider Demographics
NPI:1124488531
Name:NELSON, AUDRA (MS CCC- SLP)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials: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 1:8200 DODGE ST
Mailing Address - Street 2:CHILDREN'S HOSPITAL & MEDICAL CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-5400
Mailing Address - Fax:
Practice Address - Street 1:17809 PIERCE PLZ
Practice Address - Street 2:CHILDREN'S REHAB SPEECH THERAPY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-1035
Practice Address - Country:US
Practice Address - Phone:402-955-8355
Practice Address - Fax:402-955-8356
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist