Healthcare Provider Details

I. General information

NPI: 1750213856
Provider Name (Legal Business Name): NICOLE BASSEY MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE SOUSA MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MILL ST STE 19
HANOVER MA
02339-1641
US

IV. Provider business mailing address

22 COLONIAL DR
BRIDGEWATER MA
02324-3002
US

V. Phone/Fax

Practice location:
  • Phone: 617-640-4507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP96097
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: