Provider Demographics
NPI:1336201979
Name:LAFFIN, NICOLE CARVER
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CARVER
Last Name:LAFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1402 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1434
Mailing Address - Country:US
Mailing Address - Phone:270-991-6823
Mailing Address - Fax:
Practice Address - Street 1:718 STATE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2247
Practice Address - Country:US
Practice Address - Phone:270-991-6823
Practice Address - Fax:270-935-5090
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1336201979OtherBCBS KY
WY314002OtherBLUE CROSS BLUE SHIELD WY