Provider Demographics
NPI:1639453590
Name:CRAM, NICOLA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLA
Middle Name:MARIE
Last Name:CRAM
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 1:1821 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4329
Mailing Address - Country:US
Mailing Address - Phone:360-659-3926
Mailing Address - Fax:
Practice Address - Street 1:1821 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4329
Practice Address - Country:US
Practice Address - Phone:360-659-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL00001865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist