Provider Demographics
NPI:1285046532
Name:MAGUIRE, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E MERMAID LN
Mailing Address - Street 2:T-167
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3244
Mailing Address - Country:US
Mailing Address - Phone:845-803-1448
Mailing Address - Fax:
Practice Address - Street 1:600 REED RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3505
Practice Address - Country:US
Practice Address - Phone:610-356-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-9094-SL235Z00000X
PASL013156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist