Provider Demographics
NPI:1750515995
Name:STRONG, NICHOLE JEAN (MA, SLP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:JEAN
Last Name:STRONG
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7397
Mailing Address - Country:US
Mailing Address - Phone:518-420-8115
Mailing Address - Fax:
Practice Address - Street 1:185 MARGARET ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1837
Practice Address - Country:US
Practice Address - Phone:518-561-6361
Practice Address - Fax:518-561-6367
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019025-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist