MEDICARE: NICOLE MARIE WEISS

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	101YP2500X	Professional Counselor	4701	MN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	307551	MN
3	101YP2500X	Professional Counselor	836-6-1-15-319	ND

General Provider Information

NPI Number	:	1962834549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE WEISS

Provider Business Mailing Address
First Line	:	1540 INDEPENDENCE DR
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-4863
Country	:	US
Telephone Number	:	701-729-8471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 INDEPENDENCE DR
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-4863
Country	:	US
Telephone Number	:	701-729-8471
Fax Number	:

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

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	03/17/2026

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Directions to “ NICOLE MARIE WEISS ” Practice Location

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