Individual
KRISTEN NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP-PCE
Contact information
Practice address
534 OWL CREEK DR, POWDER SPRINGS, GA 30127-6285
(770) 361-4124
(678) 290-5587
Mailing address
534 OWL CREEK DR, POWDER SPRINGS, GA 30127-6285
(770) 361-4124
(678) 290-5587
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PCET003032
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000869096E
—
GA
Enumeration date
09/25/2019
Last updated
09/25/2019
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