Individual
LAURIANNE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2450 VINEYARD DR, PLOVER, WI 54467-3973
(715) 342-0290
(715) 342-0291
Mailing address
W5807 GLEN AVE, ENDEAVOR, WI 53930-9552
(608) 587-2556
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2738-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39267300
—
WI
Enumeration date
01/06/2007
Last updated
03/14/2008
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