Provider Demographics
NPI:1942688148
Name:NICOLIA, TERESA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:NICOLIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 MAX LOOP
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7595
Mailing Address - Country:US
Mailing Address - Phone:814-490-2081
Mailing Address - Fax:
Practice Address - Street 1:2975 MAX LOOP
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7595
Practice Address - Country:US
Practice Address - Phone:814-490-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist