Provider Demographics
NPI:1043652159
Name:NIKOLAISEN, SALENA ANN (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:SALENA
Middle Name:ANN
Last Name:NIKOLAISEN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16120 INGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8768
Mailing Address - Country:US
Mailing Address - Phone:651-788-1173
Mailing Address - Fax:
Practice Address - Street 1:16120 INGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8768
Practice Address - Country:US
Practice Address - Phone:651-788-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist