=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013150010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE CHRISTINE SHERICK M.S. CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2009
-----------------------------------------------------
Last Update Date | 04/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10100 HILLVIEW DR
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32514-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-478-5153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4718 WINTERDALE DR
-----------------------------------------------------
City | PACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32571-1371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-308-0364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA9648
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------