Provider Demographics
NPI:1811122039
Name:NICOL, LAURA ALLISON (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALLISON
Last Name:NICOL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7086 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9352
Mailing Address - Country:US
Mailing Address - Phone:269-370-2382
Mailing Address - Fax:
Practice Address - Street 1:709 LODGE LN STE 2F
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5943
Practice Address - Country:US
Practice Address - Phone:269-370-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist