Provider Demographics
NPI:1922792175
Name:AIELLO, NICOLLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLLE
Middle Name:
Last Name:AIELLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 ARBORCREST ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5005
Mailing Address - Country:US
Mailing Address - Phone:269-929-6586
Mailing Address - Fax:
Practice Address - Street 1:4017 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3731
Practice Address - Country:US
Practice Address - Phone:269-205-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009739103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling