Provider Demographics
NPI:1922390624
Name:NICHOLS, CHRISTIE MICHELLE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MICHELLE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MOORSGATE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-7743
Mailing Address - Country:US
Mailing Address - Phone:706-218-8297
Mailing Address - Fax:
Practice Address - Street 1:112 MOORSGATE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-7743
Practice Address - Country:US
Practice Address - Phone:706-218-8297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist