Individual
MAUDE LAVERNE NICKOLOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
2280 WA-821, YAKIMA, WA 98901
(509) 457-0990
Mailing address
PO BOX 217, SELAH, WA 98942-0217
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CP0000426
—
WA
Enumeration date
10/15/2018
Last updated
10/15/2018
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