Provider Demographics
NPI:1639594070
Name:FIEDLER, NICOLE JENNIFER (SLP-CCC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JENNIFER
Last Name:FIEDLER
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ROBERT CIR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3826
Mailing Address - Country:US
Mailing Address - Phone:516-672-0538
Mailing Address - Fax:
Practice Address - Street 1:20 ROBERT CIR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3826
Practice Address - Country:US
Practice Address - Phone:516-672-0538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist