Provider Demographics
NPI:1083030787
Name:NICHOLS, CYNTHIA NELL (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:NELL
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 PIN OAK TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3652
Mailing Address - Country:US
Mailing Address - Phone:419-774-0414
Mailing Address - Fax:
Practice Address - Street 1:890 W 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-2565
Practice Address - Country:US
Practice Address - Phone:419-774-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist