Healthcare Provider Details

I. General information

NPI: 1588012454
Provider Name (Legal Business Name): SOLINA KRICKOVICH M.S. ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HIGHLAND PL
LANCASTER NY
14086-1614
US

IV. Provider business mailing address

10 HIGHLAND PL
LANCASTER NY
14086-1614
US

V. Phone/Fax

Practice location:
  • Phone: 716-880-6147
  • Fax:
Mailing address:
  • Phone: 716-880-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30111
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number60996149
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number027115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: