Provider Demographics
NPI:1609689660
Name:WALSH, NICHOLAS M (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:WALSH
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 BANCROFT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-1209
Mailing Address - Country:US
Mailing Address - Phone:504-905-9671
Mailing Address - Fax:
Practice Address - Street 1:10001 LAKE FOREST BLVD STE 710
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6200
Practice Address - Country:US
Practice Address - Phone:504-905-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist