Provider Demographics
NPI:1659542207
Name:GREENWALD, NICOLE ERIN (MS, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ERIN
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3826
Mailing Address - Country:US
Mailing Address - Phone:561-391-6822
Mailing Address - Fax:561-391-6823
Practice Address - Street 1:432 PLAZA REAL
Practice Address - Street 2:APT. H333
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3941
Practice Address - Country:US
Practice Address - Phone:561-302-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist