Individual
SHELLY NICOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7507 NE 51ST ST, VANCOUVER, WA 98662-6007
(360) 906-1190
Mailing address
7507 NE 51ST ST, VANCOUVER, WA 98662-6007
(360) 906-1190
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
60620544
WA
Other
Enumeration date
06/10/2009
Last updated
03/04/2016
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