Provider Demographics
NPI:1447822267
Name:SENKIW, NICOLE ANNA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNA
Last Name:SENKIW
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GREENUP ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2569
Mailing Address - Country:US
Mailing Address - Phone:937-689-5292
Mailing Address - Fax:
Practice Address - Street 1:4250 GLENN AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1641
Practice Address - Country:US
Practice Address - Phone:859-431-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPENDING390200000X
KY272267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program