MEDICARE: ELENA NICHOLSON

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	2204001642	VA

General Provider Information

NPI Number	:	1386502847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA NICHOLSON

Provider Business Mailing Address
First Line	:	7535 LITTLE RIVER TPKE STE 101B
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-2991
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7535 LITTLE RIVER TPKE STE 101B
Second Line	:	SUITE 101B
City	:	ANNANDALE
State	:	VA
Zip	:	22003-2991
Country	:	US
Telephone Number	:	703-688-3142
Fax Number	:

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

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “ ELENA NICHOLSON ” Practice Location

Language	Start Address	Practice Location

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