Healthcare Provider Details

I. General information

NPI: 1700665213
Provider Name (Legal Business Name): NICOLE LEIGH KARP LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE LEIGH PETERSON

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PARK AVE
MINNEAPOLIS MN
55404-3378
US

IV. Provider business mailing address

3000 AMES CROSSING RD STE 600
EAGAN MN
55121-2570
US

V. Phone/Fax

Practice location:
  • Phone: 651-774-0011
  • Fax: 651-774-0606
Mailing address:
  • Phone: 651-774-0011
  • Fax: 651-774-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27977
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: