Provider Demographics
NPI:1427202951
Name:NICHOLSON, LORAINE ROBLA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORAINE
Middle Name:ROBLA
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:LORIANE
Other - Middle Name:KATHERINE
Other - Last Name:ROBLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:232 NERSESIAN RD
Mailing Address - Street 2:
Mailing Address - City:HARTWICK
Mailing Address - State:NY
Mailing Address - Zip Code:13348-2902
Mailing Address - Country:US
Mailing Address - Phone:607-293-7966
Mailing Address - Fax:
Practice Address - Street 1:232 NERSESIAN RD
Practice Address - Street 2:
Practice Address - City:HARTWICK
Practice Address - State:NY
Practice Address - Zip Code:13348-2902
Practice Address - Country:US
Practice Address - Phone:607-293-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008679-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist