Healthcare Provider Details

I. General information

NPI: 1841917614
Provider Name (Legal Business Name): NICOLE CAMPBELL MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 OHMS LN STE 450
EDINA MN
55439-2339
US

IV. Provider business mailing address

7301 OHMS LN STE 450
MINNEAPOLIS MN
55439-2339
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-2000
  • Fax:
Mailing address:
  • Phone: 612-293-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29053
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: