Healthcare Provider Details

I. General information

NPI: 1245712322
Provider Name (Legal Business Name): NATALIE ALISE NEILSON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 WEST ST STE 102
KEENE NH
03431-2412
US

IV. Provider business mailing address

372 WEST ST STE 102
KEENE NH
03431-2412
US

V. Phone/Fax

Practice location:
  • Phone: 603-338-0033
  • Fax: 603-719-1266
Mailing address:
  • Phone: 603-338-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1533
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: