Individual
MARISSA NICKEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
410 S ORCHARD ST, STE. 232, BOISE, ID 83705-1260
(208) 371-5733
Mailing address
3903 W GREENBRIER DR, BOISE, ID 83705-4522
(208) 371-5733
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-29805
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-33227
ID
Other
Enumeration date
06/29/2012
Last updated
06/13/2016
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