Provider Demographics
NPI:1073719613
Name:KRAFTSOW, NICOLE MURRAY (SLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MURRAY
Last Name:KRAFTSOW
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21205 NE 37TH AVE
Mailing Address - Street 2:#403
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4051
Mailing Address - Country:US
Mailing Address - Phone:305-933-9799
Mailing Address - Fax:305-228-6251
Practice Address - Street 1:4284 SW 161ST PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3826
Practice Address - Country:US
Practice Address - Phone:786-208-2814
Practice Address - Fax:305-228-6251
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist