Provider Demographics
NPI:1235027954
Name:WAHLERS, NICOLE R
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:WAHLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:R
Other - Last Name:WAHLERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4325 W MORTEN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1665
Mailing Address - Country:US
Mailing Address - Phone:480-415-6448
Mailing Address - Fax:
Practice Address - Street 1:4325 W MORTEN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1665
Practice Address - Country:US
Practice Address - Phone:480-415-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA129892355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant