Provider Demographics
NPI:1134356058
Name:FISTLER, NINA LINNEA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:LINNEA
Last Name:FISTLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 NASHVILLE LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-2917
Mailing Address - Country:US
Mailing Address - Phone:309-716-8449
Mailing Address - Fax:
Practice Address - Street 1:8600 US HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-2706
Practice Address - Country:US
Practice Address - Phone:130-971-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist