Provider Demographics
NPI:1316174048
Name:NIGHTINGALE, DEIDRA ANN (SLP)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:ANN
Last Name:NIGHTINGALE
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 1:9757 WINDWATER DR.
Mailing Address - Street 2:#5210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075
Mailing Address - Country:US
Mailing Address - Phone:832-362-6393
Mailing Address - Fax:
Practice Address - Street 1:9757 WINDWATER DR
Practice Address - Street 2:#5210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075
Practice Address - Country:US
Practice Address - Phone:832-362-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-21
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101832OtherTX SLP BOARD
TX101832OtherSPEECH LANGUAGE PATHOLOGIST