Provider Demographics
NPI:1710236286
Name:KAIN, NICOLE PERRY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PERRY
Last Name:KAIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7204 DUVAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-6104
Mailing Address - Country:US
Mailing Address - Phone:804-229-4418
Mailing Address - Fax:
Practice Address - Street 1:6688 MAIN STREET
Practice Address - Street 2:P.O. BOX 130
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061
Practice Address - Country:US
Practice Address - Phone:804-229-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002364235Z00000X
UT12083199-4102235Z00000X
VA2202006637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist