Provider Demographics
NPI:1053868802
Name:COOLEY, NICOLLE DENISE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLLE
Middle Name:DENISE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:NICOLLE
Other - Middle Name:DENISE
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2600 DOUGLASS ROAD SE KIPP DC: THE LEARNING CENTER
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020
Mailing Address - Country:US
Mailing Address - Phone:240-270-8649
Mailing Address - Fax:240-245-4472
Practice Address - Street 1:2600 VIRGINIA AVENUE NW
Practice Address - Street 2:SUITE #900
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-265-5477
Practice Address - Fax:240-245-4472
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01301L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist