Active NPI
Stephanie Nickson, MSW, LCSW
- Social Worker
- Woodburn, OR
National Provider Identifier
1023460946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 4527
- Practice address
- 1475 Mount Hood Ave
Woodburn, OR 97071-9066 - Phone
- (971) 983-5214
- NPI assigned
- Jul 2, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 4527 | OR | Primary |
Addresses
Primary practice location
1475 Mount Hood Ave
Woodburn, OR 97071-9066
Mailing address
PO Box 3417
Portland, OR 97208-3417
Other practice location 1
11035 NE Sandy Blvd
Portland, OR 97220-2553
Phone (503) 258-4200
Other practice location 2
1475 Mount Hood Ave
Woodburn, OR 97071-9066
Phone (971) 983-5214
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500727635 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4527 | OR | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morrison Child and Family Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Portland, OR
- NPI 1346382975
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566950400000",
"number": "1023460946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3417",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1475 MOUNT HOOD AVE",
"city": "WOODBURN",
"state": "OR",
"postal_code": "970719066",
"telephone_number": "971-983-5214"
}
],
"practiceLocations": [
{
"address_1": "11035 NE Sandy Blvd",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972202553",
"country_code": "US",
"telephone_number": "503-258-4200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1475 Mount Hood Ave",
"address_purpose": "LOCATION",
"city": "Woodburn",
"state": "OR",
"postal_code": "970719066",
"country_code": "US",
"telephone_number": "971-983-5214",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NICKSON",
"first_name": "STEPHANIE",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-02",
"last_updated": "2019-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OR",
"license": "4527",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500727635",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodburn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.