Provider Demographics
NPI:1871088906
Name:TRIETSCH, NIKOLE ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:ELIZABETH
Last Name:TRIETSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E BROADWAY APT 3C
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4139
Mailing Address - Country:US
Mailing Address - Phone:516-232-5949
Mailing Address - Fax:
Practice Address - Street 1:2501 MILBURN AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3628
Practice Address - Country:US
Practice Address - Phone:516-377-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist