Provider Demographics
NPI:1205048709
Name:NELSON, NICOLE MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:NELSON
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 1:820 LINCOLN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015
Mailing Address - Country:US
Mailing Address - Phone:610-872-3913
Mailing Address - Fax:
Practice Address - Street 1:NAAMANS CREEK COUNTRY MANOR
Practice Address - Street 2:1194 NAAMANS CREEK ROAD
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061
Practice Address - Country:US
Practice Address - Phone:610-558-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005223L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist