Provider Demographics
NPI:1619251469
Name:RICCI, NICOLE NOEL (EDD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:NOEL
Last Name:RICCI
Suffix:
Gender:F
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3042
Mailing Address - Country:US
Mailing Address - Phone:516-270-2519
Mailing Address - Fax:
Practice Address - Street 1:16-10 UTOPIA PARKWAY THIRD FLOOR, ROOM 303
Practice Address - Street 2:P9@209Q
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357
Practice Address - Country:US
Practice Address - Phone:718-352-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020949-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist