Provider Demographics
NPI:1063078137
Name:NIKITICH, OLIVIA LYNNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LYNNE
Last Name:NIKITICH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:LYNNE
Other - Last Name:MCVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:8373 NUMBER THREE ROAD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367
Mailing Address - Country:US
Mailing Address - Phone:315-744-0436
Mailing Address - Fax:315-346-6775
Practice Address - Street 1:21986 COLE RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9592
Practice Address - Country:US
Practice Address - Phone:315-493-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist