Provider Demographics
NPI:1376578914
Name:DOHAR, NICOLE LYNN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:DOHAR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:DEANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:138 GREEN BAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-965-0887
Mailing Address - Fax:330-743-1616
Practice Address - Street 1:299 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502
Practice Address - Country:US
Practice Address - Phone:330-743-1168
Practice Address - Fax:330-743-1616
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078348Medicaid
OH0078348Medicaid