Provider Demographics
NPI:1124684022
Name:ST. AMAND, NICOLE SOPHIA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SOPHIA
Last Name:ST. AMAND
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 EMERALD RD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1536
Mailing Address - Country:US
Mailing Address - Phone:413-537-3407
Mailing Address - Fax:
Practice Address - Street 1:62 EMERALD RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:MA
Practice Address - Zip Code:01543-1536
Practice Address - Country:US
Practice Address - Phone:413-537-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty