Provider Demographics
NPI:1427690155
Name:GENIS, NICOLE (AUD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GENIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MERCURY DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1939
Mailing Address - Country:US
Mailing Address - Phone:774-276-1905
Mailing Address - Fax:
Practice Address - Street 1:69 PEARSON BLVD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3368
Practice Address - Country:US
Practice Address - Phone:978-630-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4775231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist