Provider Demographics
NPI:1811562424
Name:GOTTSCHALK, NICOLE ENGLAND (AUD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ENGLAND
Last Name:GOTTSCHALK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WARNER CT
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-5009
Mailing Address - Country:US
Mailing Address - Phone:860-682-0292
Mailing Address - Fax:
Practice Address - Street 1:99 WARNER CT
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-5009
Practice Address - Country:US
Practice Address - Phone:860-682-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT231H00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist