Individual
MIKAELA C NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19800 VILLAGE OFFICE CT STE 104, BEND, OR 97702-1813
(541) 306-3483
(541) 639-8909
Mailing address
19800 VILLAGE OFFICE CT STE 104, BEND, OR 97702-1813
(541) 306-3483
(541) 639-8909
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
ABA-IN-10225094
OR
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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