Provider Demographics
NPI:1235323882
Name:NICHOLSON, CHRISTINE M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 VISTA CT
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-5313
Mailing Address - Country:US
Mailing Address - Phone:732-778-0520
Mailing Address - Fax:
Practice Address - Street 1:94 STEVENS RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1237
Practice Address - Country:US
Practice Address - Phone:732-914-1100
Practice Address - Fax:732-797-3830
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00364300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist