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NPI Code Detail

MEDICARE: MISTY NELSON LICSW, LADC

MEDICARE: MISTY NELSON LICSW, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor30426MN
21041C0700XClinical Social Worker32165MN

General Provider Information

NPI Number : 1093436941
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY NELSON LICSW, LADC
Provider Business Mailing Address
First Line : 1809 19TH AVE SW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-4946
Country : US
Telephone Number : 320-441-7000
Fax Number : 320-441-7005
Provider Business Practice Location Address
First Line : 1809 19TH AVE SW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-4946
Country : US
Telephone Number : 320-441-7000
Fax Number : 320-441-7005
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2022
Last Update Date : 12/02/2025

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