Individual
MRS. NICOLE SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
318 W WASHINGTON AVE, ABERDEEN, ID 83210-5502
(208) 397-4113
Mailing address
2947 W 1700 S, ABERDEEN, ID 83210-1628
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LMSW-40005
ID
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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