Provider Demographics
NPI:1205083011
Name:FAUQUIER, NICOLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FAUQUIER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BRACHFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7635
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-7635
Mailing Address - Country:US
Mailing Address - Phone:847-816-7200
Mailing Address - Fax:847-816-7210
Practice Address - Street 1:854 TECHNOLOGY WAY
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5350
Practice Address - Country:US
Practice Address - Phone:847-816-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist