Provider Demographics
NPI:1659671261
Name:SOLOMON, NICOLE L (MSED, CCC-CLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:MSED, CCC-CLP
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:GRUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, CCC-SLP
Mailing Address - Street 1:233 MONMOUTH WAY
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-8511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 MONMOUTH WAY
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-8511
Practice Address - Country:US
Practice Address - Phone:518-577-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 020840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist