Provider Demographics
NPI:1174919922
Name:NUESE, MAGGIE (SLP)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:NUESE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 S 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6817
Mailing Address - Country:US
Mailing Address - Phone:360-402-9241
Mailing Address - Fax:
Practice Address - Street 1:2401 BRISTOL CT SW STE D103
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6037
Practice Address - Country:US
Practice Address - Phone:360-357-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60538292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL60538292OtherSTATE HEALTH LICENSE