Provider Demographics
NPI:1942574728
Name:CHICCA, NINETTE FONSECA (NINETTE CHICCA, SLP)
Entity Type:Individual
Prefix:MRS
First Name:NINETTE
Middle Name:FONSECA
Last Name:CHICCA
Suffix:
Gender:F
Credentials:NINETTE CHICCA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 SONOMA MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-9283
Mailing Address - Country:US
Mailing Address - Phone:707-795-5709
Mailing Address - Fax:707-795-5709
Practice Address - Street 1:55 MARIA DR
Practice Address - Street 2:SUITE 842
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-9283
Practice Address - Country:US
Practice Address - Phone:707-789-9222
Practice Address - Fax:707-789-9222
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist