Provider Demographics
NPI:1750660437
Name:CRAFT, NICHOLAS HUGH (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:HUGH
Last Name:CRAFT
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1169
Mailing Address - Country:US
Mailing Address - Phone:586-651-2732
Mailing Address - Fax:
Practice Address - Street 1:1612 N 37TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5404
Practice Address - Country:US
Practice Address - Phone:715-392-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60236574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist