Provider Demographics
NPI:1962745976
Name:DORSEY, NICOLE RYAN
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:RYAN
Last Name:DORSEY
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 1:558 E COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2719
Mailing Address - Country:US
Mailing Address - Phone:626-688-4982
Mailing Address - Fax:
Practice Address - Street 1:55 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1847
Practice Address - Country:US
Practice Address - Phone:626-355-1729
Practice Address - Fax:626-836-6927
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23092355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant