Provider Demographics
NPI:1366692550
Name:FOBARE, NICOLE LYNN (BS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:FOBARE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 COACHLIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-9317
Mailing Address - Country:US
Mailing Address - Phone:585-315-5443
Mailing Address - Fax:
Practice Address - Street 1:49 COACHLIGHT CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-9317
Practice Address - Country:US
Practice Address - Phone:585-315-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist