Provider Demographics
NPI:1679036255
Name:KLEIN, NICOLE BEVERLY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BEVERLY
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:BEVERLY
Other - Last Name:SCHOENBRUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 1ST ST SE REAR LOWER
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-1804
Mailing Address - Country:US
Mailing Address - Phone:240-630-0654
Mailing Address - Fax:
Practice Address - Street 1:5606 SHIELDS DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3571
Practice Address - Country:US
Practice Address - Phone:301-493-0023
Practice Address - Fax:833-803-2521
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09130235Z00000X
MD235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist