Provider Demographics
NPI:1417245606
Name:OLDHAM, NICHOLAS ELI
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ELI
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E SLOAN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2716
Mailing Address - Country:US
Mailing Address - Phone:618-253-3277
Mailing Address - Fax:618-253-8060
Practice Address - Street 1:1220 E SLOAN ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2716
Practice Address - Country:US
Practice Address - Phone:618-253-3277
Practice Address - Fax:618-253-8060
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001391231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist