Provider Demographics
NPI:1982082616
Name:STREET, NICOLE DRAKOPOULOS (AUD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DRAKOPOULOS
Last Name:STREET
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9109 ALEXANDER COMMONS DR.
Mailing Address - Street 2:APARTMENT 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:860-463-0296
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 318
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-493-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist