MEDICARE: NICOLE MCLAUGHLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1902442197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MCLAUGHLIN

Provider Business Mailing Address
First Line	:	179 FULTON ST
Second Line	:
City	:	MASSAPEQUA PARK
State	:	NY
Zip	:	11762-2406
Country	:	US
Telephone Number	:	516-672-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 HAWKINS AVE
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-2374
Country	:	US
Telephone Number	:	631-240-3579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/21/2019

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Directions to “ NICOLE MCLAUGHLIN ” Practice Location

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