Healthcare Provider Details

I. General information

NPI: 1427083518
Provider Name (Legal Business Name): AMY N NICHOLS MSW, LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 165TH AVE NE
REDMOND WA
98052-3948
US

IV. Provider business mailing address

7409 LAKE ALICE RD SE
FALL CITY WA
98024-6703
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-2644
  • Fax: 425-867-0930
Mailing address:
  • Phone: 425-444-8861
  • Fax: 425-222-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60034577
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: