Provider Demographics
NPI:1316390792
Name:KLOPP, NICOLE CHARLYN CADENASSO (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHARLYN CADENASSO
Last Name:KLOPP
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CADENASSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1752 E BULLARD AVE
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5864
Mailing Address - Country:US
Mailing Address - Phone:559-970-8277
Mailing Address - Fax:
Practice Address - Street 1:1752 E BULLARD AVE
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5864
Practice Address - Country:US
Practice Address - Phone:559-970-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP19218235Z00000X
WALL60387131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist