Provider Demographics
NPI:1164094249
Name:NICKELS, KARYN MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:MARIE
Last Name:NICKELS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KARYN
Other - Middle Name:MARIE
Other - Last Name:O'DRISCOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:263 S 33RD ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5914
Mailing Address - Country:US
Mailing Address - Phone:908-842-4944
Mailing Address - Fax:
Practice Address - Street 1:263 S 33RD ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5914
Practice Address - Country:US
Practice Address - Phone:908-842-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist