Provider Demographics
NPI:1780851964
Name:KREISMAN, NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:KREISMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 CAMPBELL BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-5500
Mailing Address - Country:US
Mailing Address - Phone:443-725-5725
Mailing Address - Fax:443-725-5738
Practice Address - Street 1:5430 CAMPBELL BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-5500
Practice Address - Country:US
Practice Address - Phone:443-725-5725
Practice Address - Fax:443-725-5738
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01098231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist