Provider Demographics
NPI:1043851843
Name:NITCHIN, HOLLEE GINDAVANH (MCD, CF-SLP)
Entity type:Individual
Prefix:MS
First Name:HOLLEE
Middle Name:GINDAVANH
Last Name:NITCHIN
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CARMEL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2300
Mailing Address - Country:US
Mailing Address - Phone:859-781-5111
Mailing Address - Fax:
Practice Address - Street 1:100 CARMEL MANOR RD.
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075
Practice Address - Country:US
Practice Address - Phone:859-781-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2023-09-06
Deactivation Date:2023-08-10
Deactivation Code:
Reactivation Date:2023-09-06
Provider Licenses
StateLicense IDTaxonomies
LA103K00000X, 106S00000X
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician