Provider Demographics
NPI:1629197611
Name:CORNAGHIE, NICCOLE LEA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICCOLE
Middle Name:LEA
Last Name:CORNAGHIE
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 1:803 AURORA LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-3752
Mailing Address - Country:US
Mailing Address - Phone:618-922-9021
Mailing Address - Fax:618-364-0401
Practice Address - Street 1:803 AURORA LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-3752
Practice Address - Country:US
Practice Address - Phone:618-998-9209
Practice Address - Fax:618-993-4031
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-005684235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist