Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Nicole Provornov

Individual provider Speech-Language Pathologist · NPI 1366872129

Mrs. Nicole Provornov is a Speech-Language Pathologist in Trumbull, Connecticut. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2013
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Practice location Address checks out

4291 Madison Ave
Trumbull, CT 06611-2739
Phone: (917) 385-7655
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 58022604 (NY)

Record details

NPI number1366872129
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 14, 2013
Last updated in NPPESMarch 10, 2021
Certification dateMarch 10, 2021

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