Provider Demographics
NPI:1255456083
Name:KAIZEN, NICOLE ANN (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:KAIZEN
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 GILLIAN LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-5820
Mailing Address - Country:US
Mailing Address - Phone:610-250-5801
Mailing Address - Fax:
Practice Address - Street 1:GRACEDALE AVENUE
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9213
Practice Address - Country:US
Practice Address - Phone:610-746-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004211L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist