Individual
NICOLE CELESTE FOGTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
2615 E RANDOLPH AVE, ENID, OK 73701-4670
(412) 420-7164
(580) 234-2615
Mailing address
2615 E RANDOLPH AVE, ENID, OK 73701-4670
(412) 420-7164
(580) 234-2615
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5495
OK
235Z00000X
Speech-Language Pathologist
6075
TN
Other
Enumeration date
11/09/2016
Last updated
08/05/2021
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