Provider Demographics
NPI:1811631195
Name:MIKUS, NIKOLAS SEAN (AUD)
Entity Type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:SEAN
Last Name:MIKUS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W BROAD ST APT 352
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3382
Mailing Address - Country:US
Mailing Address - Phone:540-533-6682
Mailing Address - Fax:
Practice Address - Street 1:14000 CROWN CT STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1463
Practice Address - Country:US
Practice Address - Phone:703-499-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist