Provider Demographics
NPI:1992057079
Name:HALVORSON, NICOLE KAYLA KINDRED (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KAYLA KINDRED
Last Name:HALVORSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 N CENTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1231
Mailing Address - Country:US
Mailing Address - Phone:319-369-8323
Mailing Address - Fax:
Practice Address - Street 1:1079 N CENTER POINT RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1231
Practice Address - Country:US
Practice Address - Phone:319-369-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist