Provider Demographics
NPI:1649581497
Name:HOLLAND, NICOLE L (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:L
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TAYMIL RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2210
Mailing Address - Country:US
Mailing Address - Phone:914-525-5335
Mailing Address - Fax:
Practice Address - Street 1:111 TAYMIL RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2210
Practice Address - Country:US
Practice Address - Phone:914-525-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist