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NPI Code Detail

MEDICARE: NICOLE FAUQUIER CCC-SLP

MEDICARE: NICOLE FAUQUIER CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist146.005267IL

General Provider Information

NPI Number : 1205083011
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE FAUQUIER CCC-SLP
Provider Business Mailing Address
First Line : PO BOX 7635
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-7635
Country : US
Telephone Number : 847-816-7200
Fax Number : 847-816-7210
Provider Business Practice Location Address
First Line : 854 TECHNOLOGY WAY
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5350
Country : US
Telephone Number : 847-816-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2008
Last Update Date : 03/22/2023

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Directions to “ NICOLE FAUQUIER CCC-SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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