Individual
NICKY CALLICOTTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
36860 INDUSTRIAL WAY, SANDY, OR 97055-7371
(503) 826-0206
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
L11089
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/08/2008
Last updated
06/06/2024
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