Provider Demographics
NPI:1871985598
Name:VIRGIL, NIKOL L (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NIKOL
Middle Name:L
Last Name:VIRGIL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 MONTROSE CT
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF LAKEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6882
Mailing Address - Country:US
Mailing Address - Phone:815-479-9819
Mailing Address - Fax:
Practice Address - Street 1:1301 PYOTT RD STE 109
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-9796
Practice Address - Country:US
Practice Address - Phone:847-791-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist