Provider Demographics
NPI:1710236286
Name:KAIN, NICOLE PERRY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PERRY
Last Name:KAIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2695 PATTERSON ROAD
Mailing Address - Street 2:SUITE 2-73
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506
Mailing Address - Country:US
Mailing Address - Phone:970-200-2194
Mailing Address - Fax:
Practice Address - Street 1:1532 N 25TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6215
Practice Address - Country:US
Practice Address - Phone:970-200-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12083199-4102235Z00000X
CO0002364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist