Provider Demographics
NPI:1558898726
Name:FARLEY, NICOLE MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 STOKEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-3111
Mailing Address - Country:US
Mailing Address - Phone:217-622-7726
Mailing Address - Fax:
Practice Address - Street 1:1309 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2526
Practice Address - Country:US
Practice Address - Phone:314-270-2266
Practice Address - Fax:855-674-0099
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist