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General NPI Number Information
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NPI Number | 1013489434
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Entity Type | Individual
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Provider Name | NICOLE ROSE IMHOF LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/24/2018
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-293-6984
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Fax | 507-284-5745
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Provider Business Mailing Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-293-6984
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Fax | 507-284-5745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25198
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License Number State | MN
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