Provider Demographics
NPI:1447381801
Name:DEARY, NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DEARY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:37 TOWN FARM RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-1721
Mailing Address - Country:US
Mailing Address - Phone:401-481-3627
Mailing Address - Fax:
Practice Address - Street 1:37 TOWN FARM RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-1721
Practice Address - Country:US
Practice Address - Phone:401-481-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINC62944Medicaid