Provider Demographics
NPI:1497180517
Name:SIBLE, NICHOLE L (MS SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:L
Last Name:SIBLE
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:MISS
Other - First Name:NICHOLE
Other - Middle Name:L
Other - Last Name:CAMPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6980 LANDSEER DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4013
Mailing Address - Country:US
Mailing Address - Phone:724-456-7495
Mailing Address - Fax:
Practice Address - Street 1:6980 LANDSEER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4013
Practice Address - Country:US
Practice Address - Phone:724-456-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011573235Z00000X
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist