Provider Demographics
NPI:1871994251
Name:REJMENT, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:REJMENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:AMBER
Other - Last Name:DALMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:337 RALPH SAMUEL BLVD
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058-7810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:337 RALPH SAMUEL BLVD
Practice Address - Street 2:
Practice Address - City:KUNKLETOWN
Practice Address - State:PA
Practice Address - Zip Code:18058-7810
Practice Address - Country:US
Practice Address - Phone:570-977-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
PASL012590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist