Nicolle R Nichols

Individual provider Active NPI Clinical Social Worker · Bemidji, MN

NPI 1407690209 · NPPES record last updated Jun 25, 2024

Key facts

NPI
1407690209
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
Practice address
403 4TH St NW Ste 115
Bemidji, MN 56601-3155
Phone
(218) 308-8560
NPI assigned
Jun 25, 2024
Sex
Female
Sole proprietor
Yes

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
I Am Incorporated Clinical Current
since Jun 30, 2024
Accepting new patients

Locations

403 4th St NW
Ste 115
Bemidji, MN 56601
Phone (218) 214-9389

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Yes

Addresses

Primary practice location

403 4TH St NW Ste 115
Bemidji, MN 56601-3155

Mailing address

403 4TH St NW Ste 115
Bemidji, MN 56601-3155
Phone (218) 308-8560

Other providers in Bemidji, MN

All providers in Bemidji, MN · Clinical Social Worker in Minnesota

Sources for this page

Verify at the official NPI Registry.