Provider Demographics
NPI:1912504374
Name:YAKICH, NICOLE LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:YAKICH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 VERNON DR
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:PA
Mailing Address - Zip Code:15089-1101
Mailing Address - Country:US
Mailing Address - Phone:724-825-9939
Mailing Address - Fax:
Practice Address - Street 1:410 TERRACE DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8991
Practice Address - Country:US
Practice Address - Phone:724-825-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist