Provider Demographics
NPI:1538653332
Name:PERROTTA, NICOLE SUSANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:SUSANNE
Last Name:PERROTTA
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 1:3707 E LIVINGSTON DR UNIT 404
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2742
Mailing Address - Country:US
Mailing Address - Phone:310-999-8665
Mailing Address - Fax:
Practice Address - Street 1:3707 E LIVINGSTON DR UNIT 404
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-2742
Practice Address - Country:US
Practice Address - Phone:310-999-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist