Provider Demographics
NPI:1972641520
Name:NICHOLSON, WESLEY OREN (MA)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:OREN
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10537 KIBBEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2416
Mailing Address - Country:US
Mailing Address - Phone:562-266-6037
Mailing Address - Fax:
Practice Address - Street 1:10537 KIBBEE AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2416
Practice Address - Country:US
Practice Address - Phone:562-266-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist