Individual
GRACELYN N NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
547 SW 7TH ST, NEWPORT, OR 97365-4909
(541) 574-9570
(541) 574-8857
Mailing address
PO BOX 1538, NEWPORT, OR 97365-0115
(541) 574-9570
(541) 574-8857
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
113974
OR
Other
Enumeration date
05/13/2025
Last updated
05/13/2025
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