Healthcare Provider Details

I. General information

NPI: 1679042329
Provider Name (Legal Business Name): NICOLE LOUISE COLAW BCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 FOLSOM BLVD
SACRAMENTO CA
95826-3257
US

IV. Provider business mailing address

8890 KALO CT
FAIR OAKS CA
95628-6320
US

V. Phone/Fax

Practice location:
  • Phone: 916-382-4447
  • Fax:
Mailing address:
  • Phone: 209-604-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number38221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: