Blake Baker Nicholson III, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

992906 Issued in CO

Practice address

928 12TH St
Greeley, CO 80631-4024

Phone

(970) 336-4910

Fax

(970) 336-5000

NPI assigned

Feb 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

University of Kansas School of Med (KC/Wich/Sal), 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868
  Medicare reassignment Care Compare group NPD
• Joseph Yeretsian, P.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boulder, CO
  • NPI 1942668165
  Medicare reassignment NPD
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260
  NPD
• Longmont United Hospital

  • General Acute Care Hospital
  • Longmont, CO
  • NPI 1366465866
  NPD (past)

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1891769261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 FAR VIEW LN",
            "city": "ESTES PARK",
            "state": "CO",
            "postal_code": "805179049",
            "telephone_number": "970-577-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 12TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806314024",
            "telephone_number": "970-336-4910",
            "fax_number": "970-336-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "BLAKE",
        "middle_name": "BAKER",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "992906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Alan Newman
• Next Door Urgent Care LLC
• Tuan Nguyen
• Kenton C Nicholas, DDS
• Payten Jozee Nichols
• Karen Mosier Nicholson, MA, LCPC, LPC
• Rebecca Nickens, PHARMD
• Ashlie Nicklaus, PHARMD.
• Corey Nielsen
• Susan Louise Niemeyer, CRNFA

• Clinical Social Worker in Greeley, CO
• Providers in Greeley, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.