Nicole Marie Brandt, LGSW, LADC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

29623 Issued in MN

Practice address

213 Labree Ave N Ste 100
Thief River Falls, MN 56701-2022

Phone

(218) 683-5141

NPI assigned

Feb 28, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Riverview Healthcare Association

  • Substance Abuse Rehabilitation Facility
  • Thief River Falls, MN
  • NPI 1174672810
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1114673183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 LABREE AVE N STE 100",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012022",
            "telephone_number": "218-683-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 LABREE AVE N STE 100",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012022",
            "telephone_number": "218-683-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDT",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "LGSW, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-28",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305917",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "29623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Bradley Bentson, LP
• Desiree M Bertilrud, NP
• Brittney Leigh Bimler, LICSW
• Danielle Boe
• Christopher J Borgen, OD
• Bryce Allen Bray, DDS
• Mary Breitenbucher, PHD, LP
• Ronald J Brockman, MD
• Kassidy Brown, LMT
• Duane C Browning, MD

• Social Worker in Thief River Falls, MN
• Providers in Thief River Falls, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.