Provider Demographics
NPI:1316171804
Name:SLAY, NICOLE ANN (MS, BCBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:SLAY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 SMOKEY RD
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-4474
Mailing Address - Country:US
Mailing Address - Phone:334-360-1158
Mailing Address - Fax:
Practice Address - Street 1:4704 SMOKEY RD
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-4474
Practice Address - Country:US
Practice Address - Phone:334-360-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2017-107103K00000X
FL1-06-2863103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst