Provider Demographics
NPI:1720524309
Name:ACEVEDO, NICOLE TERESA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:TERESA
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B4 CALLE 3
Mailing Address - Street 2:REPARTO MARQUEZ
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-205-4364
Mailing Address - Fax:
Practice Address - Street 1:B4 CALLE 3
Practice Address - Street 2:REPARTO MARQUEZ
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3943
Practice Address - Country:US
Practice Address - Phone:787-205-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0070602355S0801X
PR004251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant