Provider Demographics
NPI:1427615178
Name:MARIANO, NICOLE ANN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:MARIANO
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 1:1653 N HALSTED ST APT CH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5556
Mailing Address - Country:US
Mailing Address - Phone:909-553-6199
Mailing Address - Fax:
Practice Address - Street 1:6850 31ST ST
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3058
Practice Address - Country:US
Practice Address - Phone:708-795-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist