Individual
MRS. JESSICA L NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-A
Contact information
Practice address
304 DETROIT ST, LA PORTE, IN 46350-2497
(219) 325-3770
(219) 325-8181
Mailing address
2022 KELLE DR, CHESTERTON, IN 46304-8708
(219) 364-4004
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23002292A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000770974
ANTHEM
IN
05
—
200387170
—
IN
Enumeration date
04/08/2008
Last updated
09/21/2020
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