Provider Demographics
NPI:1679346662
Name:PHILPOTT, NICHOLAS RAU (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RAU
Last Name:PHILPOTT
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:PHILPOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7 KENSINGTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-5023
Mailing Address - Country:US
Mailing Address - Phone:513-477-3629
Mailing Address - Fax:
Practice Address - Street 1:299 CHERRY HILL RD STE 108
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1124
Practice Address - Country:US
Practice Address - Phone:578-658-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01235200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist