Individual
STEPHANIE NICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1475 MOUNT HOOD AVE, WOODBURN, OR 97071-9066
(971) 983-5214
Mailing address
PO BOX 3417, PORTLAND, OR 97208-3417
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4527
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500727635
—
OR
Enumeration date
07/02/2016
Last updated
08/28/2019
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