Provider Demographics
NPI:1225207996
Name:HINES-STAPLES, NICKOLE A (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:NICKOLE
Middle Name:A
Last Name:HINES-STAPLES
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 1:1315 ROADRUNNER DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5105
Mailing Address - Country:US
Mailing Address - Phone:713-203-1412
Mailing Address - Fax:
Practice Address - Street 1:1601 TRINITY ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1765
Practice Address - Country:US
Practice Address - Phone:512-495-5257
Practice Address - Fax:989-774-1891
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004319235Z00000X
TX103963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103963OtherTEXAS LICENSE
MI12111764OtherASHA
MI7101004319OtherMICHIGAN LICENSE