Provider Demographics
NPI:1558647776
Name:MCNICHOLAS, DENICE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DENICE
Middle Name:
Last Name:MCNICHOLAS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2302
Mailing Address - Country:US
Mailing Address - Phone:516-483-7300
Mailing Address - Fax:
Practice Address - Street 1:307 EAGLE AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3819
Practice Address - Country:US
Practice Address - Phone:516-483-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010916-0235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist