Provider Demographics
NPI:1982471249
Name:CALLOWAY, NICOLE ANNE (MA CCC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANNE
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ANNE
Other - Last Name:SEAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC
Mailing Address - Street 1:4 LONG LN
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-2506
Mailing Address - Country:US
Mailing Address - Phone:631-329-4100
Mailing Address - Fax:631-329-4210
Practice Address - Street 1:2 LONG LN
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2506
Practice Address - Country:US
Practice Address - Phone:631-329-4182
Practice Address - Fax:631-329-4210
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist