Individual
MS. NICOLE DENISE SIDDOWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, CAC II
Contact information
Practice address
530 E 34TH ST, SUITE 102, JOPLIN, MO 64804-3924
(417) 347-7500
(417) 347-7508
Mailing address
530 E 34TH ST, SUITE 102, JOPLIN, MO 64804-3924
(417) 347-7500
(417) 347-7508
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2007035690
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497011205
—
MO
Enumeration date
03/12/2007
Last updated
06/26/2009
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