Provider Demographics
NPI:1972903094
Name:NELSON, AUDREY (MA)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 POINSETTA DR APT 10
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3551
Mailing Address - Country:US
Mailing Address - Phone:719-213-4797
Mailing Address - Fax:
Practice Address - Street 1:810 POINSETTA DR APT 10
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3551
Practice Address - Country:US
Practice Address - Phone:719-213-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist