Healthcare Provider Details

I. General information

NPI: 1417889155
Provider Name (Legal Business Name): NICOLE ALDRIDGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAIN ST STE 212
NEWPORT NEWS VA
23601-4012
US

IV. Provider business mailing address

34 MAIN ST STE 212
NEWPORT NEWS VA
23601-4012
US

V. Phone/Fax

Practice location:
  • Phone: 757-777-8660
  • Fax:
Mailing address:
  • Phone: 757-777-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN ALDRIDGE
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-777-8660