Provider Demographics
NPI:1326378142
Name:NICSINGER, ERIC (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:NICSINGER
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 TRACTION AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1680
Mailing Address - Country:US
Mailing Address - Phone:818-723-9316
Mailing Address - Fax:
Practice Address - Street 1:629 TRACTION AVE APT 112
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1680
Practice Address - Country:US
Practice Address - Phone:818-723-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist