Provider Demographics
NPI:1073927505
Name:JAOUEN, NICOLETTE MICHELLE
Entity Type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:MICHELLE
Last Name:JAOUEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W 76TH ST
Mailing Address - Street 2:APT A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8064
Mailing Address - Country:US
Mailing Address - Phone:908-377-0232
Mailing Address - Fax:
Practice Address - Street 1:309 W 76TH ST
Practice Address - Street 2:APT A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8064
Practice Address - Country:US
Practice Address - Phone:908-377-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist