Provider Demographics
NPI:1104569334
Name:CIPOLLINI, NANCY ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:CIPOLLINI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 GUNDRY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3709
Mailing Address - Country:US
Mailing Address - Phone:949-939-5107
Mailing Address - Fax:
Practice Address - Street 1:32170 NIGUEL RD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4264
Practice Address - Country:US
Practice Address - Phone:949-939-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist