Provider Demographics
NPI:1619184314
Name:NICHOL, LORI DOUGHERTY (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:DOUGHERTY
Last Name:NICHOL
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 1:201 BEECH LN
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-5412
Mailing Address - Country:US
Mailing Address - Phone:215-258-3013
Mailing Address - Fax:
Practice Address - Street 1:3075 RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403
Practice Address - Country:US
Practice Address - Phone:610-265-4700
Practice Address - Fax:610-265-3439
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005186L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist