Provider Demographics
NPI:1174833354
Name:NICHOLS, SANFORD WALDON (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:SANFORD
Middle Name:WALDON
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N 200 W
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7056
Mailing Address - Country:US
Mailing Address - Phone:801-203-4055
Mailing Address - Fax:866-519-0838
Practice Address - Street 1:280 N 200 W
Practice Address - Street 2:SUITE 270
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7056
Practice Address - Country:US
Practice Address - Phone:801-203-4055
Practice Address - Fax:866-519-0838
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2900354601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist