MEDICARE: NICOLE ANN KAIZEN SPEECH PATHOLOGIST

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
1	235Z00000X	Speech-Language Pathologist	SL004211L	PA

General Provider Information

NPI Number	:	1255456083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ANN KAIZEN SPEECH PATHOLOGIST

Provider Business Mailing Address
First Line	:	2590 GILLIAN LN
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18040-5820
Country	:	US
Telephone Number	:	610-250-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	GRACEDALE AVENUE
Second Line	:
City	:	NAZARETH
State	:	PA
Zip	:	18064-9213
Country	:	US
Telephone Number	:	610-746-1947
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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Directions to “ NICOLE ANN KAIZEN SPEECH PATHOLOGIST” Practice Location

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