Provider Demographics
NPI:1982087151
Name:GOKHMAN, NICOLE J (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:J
Last Name:GOKHMAN
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 1:25 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2729
Mailing Address - Country:US
Mailing Address - Phone:201-873-1404
Mailing Address - Fax:
Practice Address - Street 1:125 OAKLAND AVE STE 303
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2130
Practice Address - Country:US
Practice Address - Phone:201-873-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028699235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist