Provider Demographics
NPI:1720360225
Name:NICOLET, GABRIELE SOPHIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GABRIELE
Middle Name:SOPHIE
Last Name:NICOLET
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 ASPEN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2648
Mailing Address - Country:US
Mailing Address - Phone:202-306-0505
Mailing Address - Fax:202-204-0562
Practice Address - Street 1:616 ASPEN ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2648
Practice Address - Country:US
Practice Address - Phone:202-306-0505
Practice Address - Fax:202-204-0562
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000001235Z00000X
VA2202005790235Z00000X
MD04491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist