Active NPI
Nicole Waters, MA, CCC-SLP
- Speech-Language Pathologist
- Cloquet, MN
National Provider Identifier
1104763200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 417609
- Practice address
- 302 14TH St
Cloquet, MN 55720-2102 - Phone
- (218) 879-6721
- Fax
- (218) 879-6724
- NPI assigned
- Apr 29, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 417609 | MN | Primary |
Addresses
Primary practice location
302 14TH St
Cloquet, MN 55720-2102
Mailing address
302 14TH St
Cloquet, MN 55720-2102
Phone (218) 879-6721
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 417609 | MN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1777420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777420800000",
"number": "1104763200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 14TH ST",
"city": "CLOQUET",
"state": "MN",
"postal_code": "557202102",
"telephone_number": "218-879-6721",
"fax_number": "218-879-6724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 14TH ST",
"city": "CLOQUET",
"state": "MN",
"postal_code": "557202102",
"telephone_number": "218-879-6721",
"fax_number": "218-879-6724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "NICOLE",
"credential": "MA, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-04-29",
"last_updated": "2026-04-29",
"certification_date": "2026-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "417609",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cloquet, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.