Christine Michele Nicklay, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15012 Issued in MT

Practice address

2200 Great Northern Ave Apt G31
Missoula, MT 59808-1650

Phone

(406) 529-2609

Fax

(406) 258-0656

NPI assigned

Jan 10, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Chris Pilgrim Former name

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1452384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1629434485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17159",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598087159",
            "telephone_number": "406-529-2609",
            "fax_number": "406-258-0656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 GREAT NORTHERN AVE APT G31",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081650",
            "telephone_number": "406-529-2609",
            "fax_number": "406-258-0656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLAY",
        "first_name": "CHRISTINE",
        "middle_name": "MICHELE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-10",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "15012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRIS",
            "last_name": "PILGRIM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Newton B. Coutinho MD PLLC
• Next02 LLC (Blue Moose Pediatrics)
• Heather Nichols, LCPC
• William C Nichols, MD
• Kasey Joseph Nicholson, M.S., LAC
• Claire E Nickless, PA-C
• Kendra Rae Nickol, OTR/L
• Annie Tanis Nicol, LMT
• Nicole Raymond
• Delores Lynn Niehaus, LCSW

• Clinical Social Worker in Missoula, MT
• Providers in Missoula, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.