Provider Demographics
NPI:1255810891
Name:SCALICE, NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCALICE
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 1:2 KIEL AVE # 111
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2572
Mailing Address - Country:US
Mailing Address - Phone:973-858-5996
Mailing Address - Fax:
Practice Address - Street 1:11 BANTA RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2514
Practice Address - Country:US
Practice Address - Phone:973-858-5996
Practice Address - Fax:973-314-8552
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00827900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist