Provider Demographics
NPI:1699912758
Name:STRAUB, NICHOLE MICHELE (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:NICHOLE
Middle Name:MICHELE
Last Name:STRAUB
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 1:12920 LINCOLN HILL DR NE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-9790
Mailing Address - Country:US
Mailing Address - Phone:616-334-6184
Mailing Address - Fax:
Practice Address - Street 1:12920 LINCOLN HILL DR NE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9790
Practice Address - Country:US
Practice Address - Phone:616-334-6184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12125489235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist