Individual
MRS. NICOLE LYNN KAVANAGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
5783 S FAWN AVE, GILBERT, AZ 85298-0848
(480) 518-7073
Mailing address
5783 S FAWN AVE, GILBERT, AZ 85298-0848
(480) 518-7073
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
018711
NY
235Z00000X
Speech-Language Pathologist
Primary
SLP6798
AZ
Other
Enumeration date
06/03/2010
Last updated
08/07/2019
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