Individual
NICOLE CONRAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
106S00000X
Contact information
Practice address
908 MANCK DR, FORT WAYNE, IN 46814-8995
(260) 271-5285
Mailing address
908 MANCK DR, FORT WAYNE, IN 46814-8995
(260) 467-9327
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
IN
106S00000X
Behavior Technician
25-482997
IN
Other
Enumeration date
08/16/2019
Last updated
11/12/2025
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