Healthcare Provider Details

I. General information

NPI: 1306822895
Provider Name (Legal Business Name): NICOLE M. VOLD MA,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE M. ROSELAND MA,CCC-A

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVE
AMES IA
50010-5014
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5014
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4480
  • Fax: 515-239-4539
Mailing address:
  • Phone: 515-239-4480
  • Fax: 515-239-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00475
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: