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NPI Code Detail

MEDICARE: NICOLE RICHARDS MA, CCC, SLP

MEDICARE: NICOLE RICHARDS MA, 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 Pathologist018826-1NY

General Provider Information

NPI Number : 1568606481
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE RICHARDS MA, CCC, SLP
Provider Business Mailing Address
First Line : 62 CLARENDON RD
Second Line :
City : LAKE RONKONKOMA
State : NY
Zip : 11779-1651
Country : US
Telephone Number : 914-629-7947
Fax Number :
Provider Business Practice Location Address
First Line : 51 SCHOOL ST
Second Line :
City : LAKE RONKONKOMA
State : NY
Zip : 11779-2298
Country : US
Telephone Number : 631-471-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2009
Last Update Date : 08/27/2019

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