Individual
NICOLE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2291 W BROADWAY ST, MISSOULA, MT 59808-2113
(406) 532-1615
Mailing address
607 SW HIGGINS AVE, MISSOULA, MT 59803-1468
(406) 532-1900
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9686
MT
Other
Enumeration date
01/21/2015
Last updated
01/21/2015
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