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General NPI Number Information
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NPI Number | 1902525116
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Entity Type | Individual
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Provider Name | NICKOLE WOODS
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Gender | Female
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 101 E EDWARDSVILLE RD
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City | WOOD RIVER
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State | IL
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Zip | 62095-1369
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Country | US
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Telephone | 618-296-5390
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Fax |
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Provider Business Mailing Address
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Address Line | 88 S MAIN ST
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City | GLEN CARBON
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State | IL
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Zip | 62034-1415
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Country | US
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Telephone | 618-288-8085
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Fax | 618-288-8959
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150106883
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License Number State | IL
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