Provider Demographics
NPI:1275736761
Name:PASCHKE, NICOLE KIEL (MS CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KIEL
Last Name:PASCHKE
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:JUDITH
Other - Last Name:KIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCCSLP
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-6002
Mailing Address - Country:US
Mailing Address - Phone:701-780-5340
Mailing Address - Fax:701-780-1942
Practice Address - Street 1:501 N COLUMBIA RD STOP 7132
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2817
Practice Address - Country:US
Practice Address - Phone:701-777-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist