Provider Demographics
NPI:1326100629
Name:LACHANCE, NICHOLE (CCC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:LACHANCE
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 204-C
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5212
Mailing Address - Country:US
Mailing Address - Phone:907-336-7323
Mailing Address - Fax:907-277-7355
Practice Address - Street 1:4050 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 204-C
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5212
Practice Address - Country:US
Practice Address - Phone:907-336-7323
Practice Address - Fax:907-277-7355
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK90235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP6595Medicaid