Healthcare Provider Details

I. General information

NPI: 1518815182
Provider Name (Legal Business Name): NICOLE ALEXANDER BRANDLEY MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22580 KINGSTON LN
GRASS VALLEY CA
95949-7706
US

IV. Provider business mailing address

22580 KINGSTON LN
GRASS VALLEY CA
95949-7706
US

V. Phone/Fax

Practice location:
  • Phone: 530-268-2800
  • Fax: 530-268-2804
Mailing address:
  • Phone: 530-268-2800
  • Fax: 530-268-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: