Provider Demographics
NPI:1104018365
Name:NICHOLSON, KATHLEEN M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 S STATE ST STE 5A
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5148
Mailing Address - Country:US
Mailing Address - Phone:302-734-1515
Mailing Address - Fax:302-734-1591
Practice Address - Street 1:1695 S STATE ST STE 5A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5148
Practice Address - Country:US
Practice Address - Phone:302-734-1515
Practice Address - Fax:302-734-1591
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist