Provider Demographics
NPI:1356909675
Name:NICKEL, CHRISTA RUTH (AUD)
Entity type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:RUTH
Last Name:NICKEL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PINE ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5847
Mailing Address - Country:US
Mailing Address - Phone:308-850-5331
Mailing Address - Fax:
Practice Address - Street 1:1000 WHITE HORSE RD STE 510
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4411
Practice Address - Country:US
Practice Address - Phone:856-627-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-01
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist