Basic Information
| Provider Information | |||||||||
| NPI: | 1972117125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICKELL-SIMPSON | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 W WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497072929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897369815 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3630 E RIVER RD | ||||||||
| Address2: | |||||||||
| City: | OSCODA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487509026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897399173 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2020 | ||||||||
| LastUpdateDate: | 09/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801107980 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.