Nicole L Nicolas, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

2019 Wealthy St SE Apt 2
Grand Rapids, MI 49506-3011

Phone

(616) 828-2865

NPI assigned

Jun 9, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Comprehensive Therapy Center Inc

  • Voluntary or Charitable Agency
  • Grand Rapids, MI
  • NPI 1073658597

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1811556343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 WEALTHY ST SE APT 2",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063011",
            "telephone_number": "616-828-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 WEALTHY ST SE APT 2",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063011",
            "telephone_number": "616-828-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLAS",
        "first_name": "NICOLE",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-09",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Philip Nickerson, CRNA
• Robert J Nickerson, PTA
• Jesse Bryan Nicodemus, MOT
• Sonia Nicola
• Lillian Ann Nicolas
• Malea Nicolet, LLPC
• Nicholas William Nicoletti
• Rashea Crystal Nidefski, LBSW
• Jennifer Niedzwiecki, PHARMD
• Thomas Niedzwiecki

• Speech-Language Pathologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Speech-Language Pathologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.