Individual
LEIGH-DEMETRA NICKLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, SC-C
Contact information
Practice address
15251 PLEASANT VALLEY RD, CENTER CITY, MN 55012-9640
(651) 213-4075
(651) 213-4888
Mailing address
15251 PLEASANT VALLEY RD, CENTER CITY, MN 55012-9640
(651) 213-4075
(651) 213-4888
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
306810
MN
Other
Enumeration date
10/15/2025
Last updated
10/15/2025
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