| Doctor Name: | KRISTINE B NICHOLS |
| NPI Number: | 1003123449 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | SLPA6911 |
| Business Practice Address: | 20402 N 15th Ave Phoenix, AZ - 850273636 |
| Business Phone Number: | 6234454952 |
| Business Fax Number: | 6234455079 |
| Mailing Address: | 20402 N 15th Ave, PHOENIX |
| State: | AZ |
| Postal Code: | 850273636 |
| Phone Number: | 6234454952 |
| Fax Number: | 6234455079 |
| NPI Enumeration Date: | 09/07/2010 |
| NPI Last Update Date: | 09/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2355S0801X |
| License Number: | SLPA6911 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | Speech-Language Assistant |
| Taxonomy Definition: | |