Provider Demographics
NPI:1285778704
Name:NICHOLAS, JOELLE MARIANNE (MS SPEECH PATHOLOG)
Entity type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:MARIANNE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MS SPEECH PATHOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2314
Mailing Address - Country:US
Mailing Address - Phone:631-696-2760
Mailing Address - Fax:
Practice Address - Street 1:31 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2314
Practice Address - Country:US
Practice Address - Phone:631-696-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist