Provider Demographics
NPI:1255657268
Name:PERMAN, NICOLE M (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:PERMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W BEATON DR
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2657
Mailing Address - Country:US
Mailing Address - Phone:701-356-0062
Mailing Address - Fax:701-356-5412
Practice Address - Street 1:720 14TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-4046
Practice Address - Country:US
Practice Address - Phone:605-216-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55666Medicaid