Provider Demographics
NPI:1437535754
Name:NICHOLS, ALEXANDRIA (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRIA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2417
Mailing Address - Country:US
Mailing Address - Phone:814-440-3296
Mailing Address - Fax:
Practice Address - Street 1:407 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2417
Practice Address - Country:US
Practice Address - Phone:814-440-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist