Provider Demographics
NPI:1316150238
Name:NICHOLLS, ASHLEIGH NICOLE (BS IN SLP)
Entity type:Individual
Prefix:MS
First Name:ASHLEIGH
Middle Name:NICOLE
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:BS IN SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 E TANQUE VERDE RD APT 32201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-7768
Mailing Address - Country:US
Mailing Address - Phone:703-283-8337
Mailing Address - Fax:
Practice Address - Street 1:5656 EAST GRANT ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-7768
Practice Address - Country:US
Practice Address - Phone:520-885-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP L5371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ180623Medicaid