Provider Demographics
NPI:1164290789
Name:KLAIPS-WILLIS, NICOLE FRANCES (HIS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:FRANCES
Last Name:KLAIPS-WILLIS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S MARKET ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2903
Mailing Address - Country:US
Mailing Address - Phone:717-492-9799
Mailing Address - Fax:
Practice Address - Street 1:1255 S MARKET ST STE 102
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2903
Practice Address - Country:US
Practice Address - Phone:717-492-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03915237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist