Provider Demographics
NPI:1740554401
Name:WAJDA, NICHOLE LYNNE (SLPA)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:LYNNE
Last Name:WAJDA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8273
Mailing Address - Country:US
Mailing Address - Phone:815-467-2744
Mailing Address - Fax:
Practice Address - Street 1:104 NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-8273
Practice Address - Country:US
Practice Address - Phone:815-467-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2170002422355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant