Provider Demographics
NPI:1245478163
Name:NOBLE, NICOLE CLEMENTE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CLEMENTE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:VICTORIA
Other - Last Name:CLEMENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5135
Mailing Address - Country:US
Mailing Address - Phone:602-349-2078
Mailing Address - Fax:
Practice Address - Street 1:40 WEAVER ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5135
Practice Address - Country:US
Practice Address - Phone:602-349-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33175235Z00000X
AZ5831235Z00000X
CA13227235Z00000X
CT6409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13227OtherSPEECH LANGUAGE PATHOLOGIST
CT6409OtherSPEECH-LANGUAGE PATHOLOGIST
AZ5831OtherSPEECH LANGUAGE PATHOLOGIST LISCENCE NUMBER
NY33175OtherSPEECH LANGUAGE PATHOLOGY