Provider Demographics
NPI:1902555691
Name:ANDERZON, NICOLE (SLPA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ANDERZON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 SW 152ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2147
Mailing Address - Country:US
Mailing Address - Phone:786-302-6124
Mailing Address - Fax:
Practice Address - Street 1:103200 OVERSEAS HWY STE 5
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2827
Practice Address - Country:US
Practice Address - Phone:305-490-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant