Provider Demographics
NPI:1700213303
Name:GRIFFIN, NICOLE JEANINE (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEANINE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4015
Mailing Address - Country:US
Mailing Address - Phone:856-689-4335
Mailing Address - Fax:
Practice Address - Street 1:1320 OLD CHAIN BRIDGE RD
Practice Address - Street 2:UNIT #185
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3956
Practice Address - Country:US
Practice Address - Phone:703-942-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006450231H00000X
VA2201000693237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist