Individual
NICOLE CHRISTINE HATHAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
6530 SW 30TH AVE, PORTLAND, OR 97239-1007
(503) 244-7533
Mailing address
2 JEFFERSON PKWY APT C1, LAKE OSWEGO, OR 97035-8892
(602) 653-9299
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15438
OR
235Z00000X
Speech-Language Pathologist
87631074102
UT
235Z00000X
Speech-Language Pathologist
SLP6141
AZ
Other
Enumeration date
06/30/2011
Last updated
12/18/2014
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