Individual
MS. NICKY DIANE BREDESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW LMFT
Contact information
Practice address
4005 WEST 65TH ST, #108, EDINA, MN 55435-1700
(952) 929-1819
(952) 929-0022
Mailing address
4005 WEST 65TH ST, #108, EDINA, MN 55435-1700
(952) 929-1819
(952) 929-0022
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
L.I.C.S.W. 257
MN
106H00000X
Marriage & Family Therapist
Primary
L.M.F.T.564
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LICSW257
LICENSE NUMBER
MN
01
—
LMFT564
LICENSE NUMBER
MN
Enumeration date
12/19/2006
Last updated
09/11/2025
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