Provider Demographics
NPI:1053731562
Name:BISHOP, NICOLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BISHOP
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 1:3511 TOWN CENTER BLVD S STE 103
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1463
Mailing Address - Country:US
Mailing Address - Phone:832-292-6800
Mailing Address - Fax:
Practice Address - Street 1:3511 TOWN CENTER BLVD S STE 103
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1463
Practice Address - Country:US
Practice Address - Phone:832-292-6800
Practice Address - Fax:346-309-2813
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108750235Z00000X
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist