Healthcare Provider Details

I. General information

NPI: 1871417600
Provider Name (Legal Business Name): NICOLE COCCODRILLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLE COCCODRILLI

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5708 VENTURE CT STE B
KALAMAZOO MI
49009-2858
US

IV. Provider business mailing address

5708 VENTURE CT STE B
KALAMAZOO MI
49009-2858
US

V. Phone/Fax

Practice location:
  • Phone: 269-459-1818
  • Fax: 269-365-9951
Mailing address:
  • Phone: 269-459-1818
  • Fax: 269-365-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6352001268
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: