Provider Demographics
NPI:1528248622
Name:LEGE, NIKI SMITH (SLP, CCC)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:SMITH
Last Name:LEGE
Suffix:
Gender:M
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 9TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8030
Mailing Address - Country:US
Mailing Address - Phone:409-722-5437
Mailing Address - Fax:409-722-5435
Practice Address - Street 1:8700 9TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8030
Practice Address - Country:US
Practice Address - Phone:409-722-5437
Practice Address - Fax:409-722-5435
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist