MEDICARE: JAMIE A NICHOLS M.S. SLP-CCC

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	SP12646	CA

General Provider Information

NPI Number	:	1477789485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE A NICHOLS M.S. SLP-CCC

Provider Business Mailing Address
First Line	:	41689 ENTERPRISE CIR N
Second Line	:	SUITE 118
City	:	TEMECULA
State	:	CA
Zip	:	92590-5630
Country	:	US
Telephone Number	:	951-541-0615
Fax Number	:	951-332-9498

Provider Business Practice Location Address
First Line	:	41689 ENTERPRISE CIR N
Second Line	:	SUITE 118
City	:	TEMECULA
State	:	CA
Zip	:	92590-5630
Country	:	US
Telephone Number	:	951-541-0615
Fax Number	:	951-332-9498

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

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	02/08/2011

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Directions to “ JAMIE A NICHOLS M.S. SLP-CCC” Practice Location

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