Provider Demographics
NPI:1821656679
Name:SICKLES, CHLOE NICOLE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:NICOLE
Last Name:SICKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WINOOSKI FALLS WAY UNIT 418
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2280
Mailing Address - Country:US
Mailing Address - Phone:518-764-0840
Mailing Address - Fax:
Practice Address - Street 1:300 PEARL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8531
Practice Address - Country:US
Practice Address - Phone:518-764-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0134189-PROV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist