Healthcare Provider Details

I. General information

NPI: 1609352228
Provider Name (Legal Business Name): NICOLE AUER GILMAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5933 GRIMES AVE S
EDINA MN
55424-1936
US

IV. Provider business mailing address

5933 GRIMES AVE S
EDINA MN
55424-1936
US

V. Phone/Fax

Practice location:
  • Phone: 612-205-3098
  • Fax:
Mailing address:
  • Phone: 612-205-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC905
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: