Nicole Rae Waugh, LLMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6851116582 Issued in MI

Practice address

300 68TH St SE
Grand Rapids, MI 49548-6927

Phone

(616) 455-5000

Fax

(248) 281-6459

NPI assigned

Mar 15, 2021

Reactivated

Jun 19, 2023

Last updated

Jun 20, 2023By the provider in NPPES

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

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

{
    "created_epoch": "1615766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1205411956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000",
            "fax_number": "248-281-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000",
            "fax_number": "248-281-6459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "346 68th St SW",
            "address_purpose": "LOCATION",
            "city": "Kentwood",
            "state": "MI",
            "postal_code": "495487179",
            "country_code": "US",
            "telephone_number": "616-202-5161",
            "fax_number": "248-712-4381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAUGH",
        "first_name": "NICOLE",
        "middle_name": "RAE",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-15",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "deactivation_date": "2023-05-31",
        "reactivation_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6851116582",
            "primary": true
        },
        {
            "code": "156F00000X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilbur K Watson III
• Marla Watts-Pacheco, BCBA, LBA
• Carolyn Watts, MD
• Isaac Gordon Watts, M.A., L.P.C.
• Elise Waugh
• Trisha Marie Waun, LMSW, CAADC
• Way to Thrive
• Derek Lee Way
• Elizabeth Way, PA-C
• Holly Way, RPH

• Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.