MEDICARE: MS. NICOLE MARIE FARLEY M.S., 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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1558898726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE MARIE FARLEY M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2505 STOKEBRIDGE RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-3111
Country	:	US
Telephone Number	:	217-622-7726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 S 9TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-2526
Country	:	US
Telephone Number	:	314-270-2266
Fax Number	:	855-674-0099

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

Provider Enumeration Date	:	05/17/2017
Last Update Date	:	10/11/2019

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