Individual
MRS. NICOLE PROVORNOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4291 MADISON AVE, TRUMBULL, CT 06611-2739
(917) 385-7655
Mailing address
4291 MADISON AVE, TRUMBULL, CT 06611-2739
(917) 385-7655
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
58022604
NY
Other
Enumeration date
11/14/2013
Last updated
03/10/2021
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