Nicole L Dufour, L.I.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

17089 Issued in MN

Practice address

1875 Station Pkwy NW
Andover, MN 55304

Phone

(763) 482-9598

Fax

(612) 235-6447

NPI assigned

Sep 3, 2009

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Relate Inc

  • Community/Behavioral Health Agency
  • Minnetonka, MN
  • NPI 1053486902
  NPD (past)
• Rum River Counseling, Inc.

  • Marriage & Family Therapist
  • Andover, MN
  • NPI 1073578472

  Clinical

  NPD (past)

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

{
    "created_epoch": "1251936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1992938237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598",
            "fax_number": "612-235-6447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "55304",
            "telephone_number": "763-482-9598",
            "fax_number": "612-235-6447"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15320 Minnetonka Blvd",
            "address_2": "#200 Relate Inc.",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "55345",
            "country_code": "US",
            "telephone_number": "952-932-7277",
            "fax_number": "952-932-9827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUFOUR",
        "first_name": "NICOLE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "L.I.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-03",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "17089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Marie Doberstein, MS, LMFT
• Brittany N Dokter, MD
• Ellen Dorr
• Kristina Dose, MA, SLLP-CF/DE
• Mannou Wend-Yam Douti, SURGICAL ASSISTANT
• Haley Dugan, OTR
• Jaya Durvasula
• Anna Ellis, MA, LADC, LPCC
• Laura Ann Ellos, M.A., CCC-SLP
• Sophia Alexandra Erdahl

• All providers in Andover, MN
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; 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.