Provider Demographics
NPI:1063778843
Name:GESSNER, NICOLE SAWYER (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SAWYER
Last Name:GESSNER
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:SEONGHEE
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 SALTMEADOW BAY ARCH
Mailing Address - Street 2:109
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6287
Mailing Address - Country:US
Mailing Address - Phone:570-713-5567
Mailing Address - Fax:
Practice Address - Street 1:2135 GENERAL BOOTH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5881
Practice Address - Country:US
Practice Address - Phone:757-430-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist