Provider Demographics
NPI:1457527541
Name:LAFFAN, NICOLE R (AUD, CCC-A/SLP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:R
Last Name:LAFFAN
Suffix:
Gender:F
Credentials:AUD, CCC-A/SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LAFFAN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-4037
Mailing Address - Country:US
Mailing Address - Phone:617-291-3999
Mailing Address - Fax:
Practice Address - Street 1:503 BERHAKIS BUILDING
Practice Address - Street 2:30 LEON ST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-373-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5840235Z00000X
MA713231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist