Provider Demographics
NPI:1376910778
Name:BELLIVEAU, NICOLE ASHLEY (SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ASHLEY
Last Name:BELLIVEAU
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 NW 7TH CIR
Mailing Address - Street 2:APT 4210
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7524
Mailing Address - Country:US
Mailing Address - Phone:786-457-8555
Mailing Address - Fax:
Practice Address - Street 1:9609 NW 7TH CIR
Practice Address - Street 2:APT 4210
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7524
Practice Address - Country:US
Practice Address - Phone:786-457-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7246235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist