Provider Demographics
NPI:1427210558
Name:NICOLOSI, AMY LEONARDO (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEONARDO
Last Name:NICOLOSI
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3912
Mailing Address - Country:US
Mailing Address - Phone:508-481-6123
Mailing Address - Fax:
Practice Address - Street 1:400 BOLTON ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3912
Practice Address - Country:US
Practice Address - Phone:508-481-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist