Basic Information
| Provider Information | |||||||||
| NPI: | 1306992490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLAS | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FISHER | ||||||||
| OtherFirstName: | WENDY | ||||||||
| OtherMiddleName: | K | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 534 DIETZ RD | ||||||||
| Address2: | |||||||||
| City: | WATSONTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177777824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705249477 | ||||||||
| FaxNumber: | 5703228029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178371236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705249477 | ||||||||
| FaxNumber: | 5703228029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW125646 | PA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.