Provider Demographics
NPI:1114146644
Name:NICHOLAS, LESLIE DENISE (MA)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:DENISE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8391 DELAWARE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221
Mailing Address - Country:US
Mailing Address - Phone:303-469-3815
Mailing Address - Fax:303-429-4020
Practice Address - Street 1:8391 DELAWARE
Practice Address - Street 2:SUITE 202
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-429-4031
Practice Address - Fax:303-429-4020
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07001662Medicaid