Provider Demographics
NPI:1295124717
Name:NICHOLS, ASHLEIGH PATRICIA
Entity type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:PATRICIA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ASHLEIGH
Other - Middle Name:PATRICIA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13016 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2126
Mailing Address - Country:US
Mailing Address - Phone:630-651-0917
Mailing Address - Fax:
Practice Address - Street 1:13016 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2126
Practice Address - Country:US
Practice Address - Phone:630-651-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL768773222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist