Healthcare Provider Details

I. General information

NPI: 1699476259
Provider Name (Legal Business Name): NICHOLAS P WOODRUFF-SIMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 30TH AVE NW
NEW BRIGHTON MN
55112-3116
US

IV. Provider business mailing address

7525 MITCHELL RD STE 100
EDEN PRAIRIE MN
55344-1900
US

V. Phone/Fax

Practice location:
  • Phone: 773-456-9616
  • Fax:
Mailing address:
  • Phone: 612-924-3807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03300
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: