Provider Demographics
NPI:1093248528
Name:ANDERSON, NICOLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ANDERSON
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 1:9907 NE 124TH ST
Mailing Address - Street 2:APT. 816
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3752
Mailing Address - Country:US
Mailing Address - Phone:509-496-6544
Mailing Address - Fax:
Practice Address - Street 1:9907 NE 124TH ST
Practice Address - Street 2:APT. 816
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3752
Practice Address - Country:US
Practice Address - Phone:509-496-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist