Provider Demographics
NPI:1679717987
Name:ESTEVEZ CAMPOS, NIXSALIZ (MS SLP)
Entity type:Individual
Prefix:
First Name:NIXSALIZ
Middle Name:
Last Name:ESTEVEZ CAMPOS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 74TH ST
Mailing Address - Street 2:APT 1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2239
Mailing Address - Country:US
Mailing Address - Phone:646-533-3803
Mailing Address - Fax:347-497-5657
Practice Address - Street 1:150 74TH ST
Practice Address - Street 2:APT 1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2239
Practice Address - Country:US
Practice Address - Phone:646-533-3803
Practice Address - Fax:347-497-5657
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0187501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist