Provider Demographics
NPI:1144597840
Name:SALADIN, NICKOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICKOLE
Middle Name:
Last Name:SALADIN
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 1:4760 DARTMOOR LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3340
Mailing Address - Country:US
Mailing Address - Phone:404-512-6559
Mailing Address - Fax:678-894-8434
Practice Address - Street 1:4760 DARTMOOR LN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3340
Practice Address - Country:US
Practice Address - Phone:404-512-6559
Practice Address - Fax:678-894-8434
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA095372128BMedicaid