Individual
MARY KATHERINE NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
407 MAIN ST SW, RONAN, MT 59864-2710
(406) 210-8831
Mailing address
PO BOX 528, BETHEL, AK 99559
(907) 543-6100
(907) 543-6008
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
189560
AK
1041C0700X
Clinical Social Worker
Primary
66438
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH0150
—
AK
Enumeration date
10/16/2012
Last updated
12/01/2023
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