Provider Demographics
NPI:1568682995
Name:NICOLICI, CHRISTINA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:NICOLICI
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:PO BOX 4418
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-0042
Mailing Address - Country:US
Mailing Address - Phone:206-769-0980
Mailing Address - Fax:866-249-4884
Practice Address - Street 1:5700 23RD DR W
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1570
Practice Address - Country:US
Practice Address - Phone:206-769-0980
Practice Address - Fax:866-249-4884
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL4624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist