Healthcare Provider Details

I. General information

NPI: 1578124160
Provider Name (Legal Business Name): NIKKI HENDRICKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W NORFOLK AVE
NORFOLK NE
68701-5340
US

IV. Provider business mailing address

1112 E MEADOW RIDGE RD
NORFOLK NE
68701-7204
US

V. Phone/Fax

Practice location:
  • Phone: 308-991-0873
  • Fax:
Mailing address:
  • Phone: 308-991-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NIKKI ANN HENDRICKSON
Title or Position: SOCIAL WORKER
Credential: PCMSW, PLMHP
Phone: 308-991-0873