Provider Demographics
NPI:1457149858
Name:KHVALABOV, NICOLE SARAH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SARAH
Last Name:KHVALABOV
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 APPLE HILL CT N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4650
Mailing Address - Country:US
Mailing Address - Phone:847-212-5103
Mailing Address - Fax:
Practice Address - Street 1:2820 S ORCAS ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-3066
Practice Address - Country:US
Practice Address - Phone:206-252-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA578981C235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist