Provider Demographics
NPI:1306822895
Name:VOLD, NICOLE M (MA,CCC-A)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:VOLD
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:ROSELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-A
Mailing Address - Street 1:1215 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4480
Mailing Address - Fax:515-239-4539
Practice Address - Street 1:1215 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5014
Practice Address - Country:US
Practice Address - Phone:515-239-4480
Practice Address - Fax:515-239-4539
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00475231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0448464Medicaid