Provider Demographics
NPI:1134225667
Name:NEAL, NICOLE JENNIFER (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JENNIFER
Last Name:NEAL
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:JENNIFER
Other - Last Name:LUKASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:57 NE VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5816
Mailing Address - Country:US
Mailing Address - Phone:603-540-6546
Mailing Address - Fax:
Practice Address - Street 1:51 S CURTISVILLE RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5909
Practice Address - Country:US
Practice Address - Phone:603-225-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3073388Medicaid