Provider Demographics
NPI:1699540674
Name:SCHAUB, NICOLE DANIELLE
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DANIELLE
Last Name:SCHAUB
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 1:10863 E 16 RD
Mailing Address - Street 2:
Mailing Address - City:MANTON
Mailing Address - State:MI
Mailing Address - Zip Code:49663
Mailing Address - Country:US
Mailing Address - Phone:231-839-2242
Mailing Address - Fax:
Practice Address - Street 1:10863 E 16 RD
Practice Address - Street 2:
Practice Address - City:MANTON
Practice Address - State:MI
Practice Address - Zip Code:49663
Practice Address - Country:US
Practice Address - Phone:231-839-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist