Provider Demographics
NPI:1669625745
Name:GUTTMAN, NICOLE BLAKE (MA SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:BLAKE
Last Name:GUTTMAN
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 ROWE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-4222
Mailing Address - Country:US
Mailing Address - Phone:516-967-9289
Mailing Address - Fax:
Practice Address - Street 1:66 ROWE AVENUE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-4222
Practice Address - Country:US
Practice Address - Phone:516-967-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011602-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist