Provider Demographics
NPI:1477296598
Name:KING, NICOLETTE L (MS CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:NICOLETTE
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BIRNUM WOODS RD
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2204
Mailing Address - Country:US
Mailing Address - Phone:603-303-3122
Mailing Address - Fax:
Practice Address - Street 1:7 GREENLEAF WOODS DR UNIT 201
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5444
Practice Address - Country:US
Practice Address - Phone:207-590-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist