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NPI Code Detail

MEDICARE: NIKI L SIDLE MSW, LISW-S

MEDICARE: NIKI L SIDLE MSW, LISW-S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.1440141OH

General Provider Information

NPI Number : 1811314321
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKI L SIDLE MSW, LISW-S
Provider Business Mailing Address
First Line : 203 HELDMAN STREET
Second Line :
City : JENERA
State : OH
Zip : 45841
Country : US
Telephone Number : 419-306-3503
Fax Number :
Provider Business Practice Location Address
First Line : 2895 HARDING HWY STE D
Second Line :
City : LIMA
State : OH
Zip : 45804-3464
Country : US
Telephone Number : 419-221-2821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2014
Last Update Date : 12/04/2025

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