Provider Demographics
NPI:1215573514
Name:INNES, NANCY A (AUD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:INNES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:BLOEBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7201 WYOMING SPRINGS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4311
Mailing Address - Country:US
Mailing Address - Phone:512-255-8070
Mailing Address - Fax:512-255-9060
Practice Address - Street 1:7201 WYOMING SPRINGS DR STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4311
Practice Address - Country:US
Practice Address - Phone:512-255-8070
Practice Address - Fax:512-255-9060
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51042231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51042OtherTEXAS LICENSE