Individual
NICOLE ANNETTE NICKSIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2906 HIGHWAY AVE, HIGHLAND, IN 46322-1631
(219) 513-8311
Mailing address
7538 MAPLEWOOD AVE, HAMMOND, IN 46324-3046
(219) 902-4182
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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