Provider Demographics
NPI:1710217732
Name:STREICH, NICOLE DIANE (MS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DIANE
Last Name:STREICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DIANE
Other - Last Name:STREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:6802 S OLYMPIA AVE
Mailing Address - Street 2:STE. 275
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1823
Mailing Address - Country:US
Mailing Address - Phone:918-508-7601
Mailing Address - Fax:918-508-7602
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:STE. 275
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1823
Practice Address - Country:US
Practice Address - Phone:918-508-7601
Practice Address - Fax:918-508-7602
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist