Provider Demographics
NPI:1093034779
Name:NICHOLS SPEECH PATHOLOGY AND THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:NICHOLS SPEECH PATHOLOGY AND THERAPY SERVICES, INC.
Other - Org Name:NICHOLS SPEECH, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:951-541-0615
Mailing Address - Street 1:41689 ENTERPRISE CR. NO.
Mailing Address - Street 2:SUITE 118
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590
Mailing Address - Country:US
Mailing Address - Phone:951-541-0615
Mailing Address - Fax:951-296-1943
Practice Address - Street 1:41689 ENTERPRISE CR. NO.
Practice Address - Street 2:SUITE 118
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590
Practice Address - Country:US
Practice Address - Phone:951-541-0615
Practice Address - Fax:951-296-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty