Individual
NICOLE VIETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3362 UNIVERSITY AVE, WATERLOO, IA 50701-2006
(319) 235-6571
Mailing address
8915 SW CENTER ST, TIGARD, OR 97223-6307
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12062
IA
101YM0800X
Mental Health Counselor
001437
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XQW496AD2124
BLUECROSS BLUESHIELD
IA
Enumeration date
04/05/2017
Last updated
03/17/2018
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