Healthcare Provider Details

I. General information

NPI: 1124696232
Provider Name (Legal Business Name): MAURICA LADAUGHN NELSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W JENICEK LOOP
POST FALLS ID
83854-4988
US

IV. Provider business mailing address

4815 N ASSEMBLY ST
SPOKANE WA
99205-6185
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-6467
  • Fax: 509-434-7156
Mailing address:
  • Phone: 509-434-7319
  • Fax: 509-434-7156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number39314
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: