Nicole Bacan, MA, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

002213 Issued in IA

Practice address

709 Iowa St
Sioux City, IA 51105-1945

Phone

(712) 522-2961

NPI assigned

Feb 19, 2014

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 19, 2014.

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392768000000",
    "number": "1275958845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 IOWA ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 IOWA ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051945",
            "telephone_number": "712-522-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACAN",
        "first_name": "NICOLE",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-19",
        "last_updated": "2014-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IA",
            "license": "002213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avera McKennan
• Avera McKennan
• Rena Avery, D.O.
• Wendy Christina Avina, CADC
• Michelle Axdahl
• Mary E Bachman, LMSW
• Shelly Kay Backhaus, LISW
• Sydney Ann Backstrom, PHARMD
• Robert Baczwaski, CRNA
• Nicole Elaine Badders

• All providers in Sioux City, IA
• Speech-Language Pathologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.