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General NPI Number Information
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NPI Number | 1215362041
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Entity Type | Individual
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Provider Name | NICOLE DEDERICH M.A. CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 900 GAGEL AVE
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City | LOUISVILLE
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State | KY
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Zip | 40216-4012
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Country | US
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Telephone | 502-368-5827
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Fax |
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Provider Business Mailing Address
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Address Line | 4822 STANLEY FARM CT
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City | LA GRANGE
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State | KY
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Zip | 40031-6714
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Country | US
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Telephone | 712-229-6819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22007228A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 140527
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License Number State | KY
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