Active NPI
Deanna Lynn Nikodym, M.A.
- Speech-Language Pathologist
- Eagle, ID
National Provider Identifier
1952793358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP-2683
- Practice address
- 935 E Winding Creek Dr
Eagle, ID 83616-7240 - Phone
- (208) 938-4748
- NPI assigned
- Feb 23, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | SLP-2683 | ID | Primary |
Addresses
Primary practice location
935 E Winding Creek Dr
Eagle, ID 83616-7240
Mailing address
935 E Winding Creek Dr
Eagle, ID 83616-7240
Phone (208) 938-4748
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 |
|---|---|---|---|
| SLP-2683 | ID | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424649600000",
"number": "1952793358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "935 E WINDING CREEK DR",
"city": "EAGLE",
"state": "ID",
"postal_code": "836167240",
"telephone_number": "208-938-4748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "935 E WINDING CREEK DR",
"city": "EAGLE",
"state": "ID",
"postal_code": "836167240",
"telephone_number": "208-938-4748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKODYM",
"first_name": "DEANNA",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-23",
"last_updated": "2015-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "SLP-2683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.