Provider Demographics
NPI:1639308505
Name:ANNICELLI, NICOLLE LAURA
Entity Type:Individual
Prefix:MS
First Name:NICOLLE
Middle Name:LAURA
Last Name:ANNICELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SCENIC RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1738
Mailing Address - Country:US
Mailing Address - Phone:203-421-3468
Mailing Address - Fax:
Practice Address - Street 1:59 HARRINGTON CT
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1207
Practice Address - Country:US
Practice Address - Phone:860-537-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist