MEDICARE: NICOLE LEIGH VANDERHOOF MA, LPCC

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
1	101YM0800X	Mental Health Counselor	4014	MN

General Provider Information

NPI Number	:	1881280121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LEIGH VANDERHOOF MA, LPCC

Provider Business Mailing Address
First Line	:	720 5TH AVE SE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-7308
Country	:	US
Telephone Number	:	507-990-1908
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 CAMPUS DR SE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4744
Country	:	US
Telephone Number	:	507-322-3019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2020
Last Update Date	:	10/05/2023

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