Provider Demographics
NPI:1275115776
Name:JESWALD, NICOLE (MA, CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:JESWALD
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 STEINER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4652
Mailing Address - Country:US
Mailing Address - Phone:216-272-8875
Mailing Address - Fax:
Practice Address - Street 1:500 TAMAL PLZ
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1151
Practice Address - Country:US
Practice Address - Phone:216-272-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist