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General NPI Number Information
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NPI Number | 1477823086
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Entity Type | Individual
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Provider Name | NIKKI LEE GUDENSCHWAGER
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Gender | Female
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 50 MOODY ST
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City | SACO
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State | ME
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Zip | 04072-1536
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Country | US
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Telephone | 207-294-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 4 BOODY ST
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City | PORTLAND
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State | ME
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Zip | 04102-2105
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Country | US
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Telephone | 207-245-0133
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | XL3834
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1636-226
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC4325
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License Number State | ME
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