Provider Demographics
NPI:1588167183
Name:NICHOLLS, JULIA KATHERINE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:KATHERINE
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 HILL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4653
Mailing Address - Country:US
Mailing Address - Phone:310-403-9547
Mailing Address - Fax:
Practice Address - Street 1:1021 HILL ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4653
Practice Address - Country:US
Practice Address - Phone:310-403-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist