Provider Demographics
NPI:1154906451
Name:HIXSON, KORI (SLP)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:HIXSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 S 86TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6053
Mailing Address - Country:US
Mailing Address - Phone:402-484-0326
Mailing Address - Fax:402-484-0229
Practice Address - Street 1:5760 S 86TH ST STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-6053
Practice Address - Country:US
Practice Address - Phone:402-484-0326
Practice Address - Fax:402-484-0229
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2496OtherLICENSE