MEDICARE: MRS. LAURIE LYNN NICOL LCSW

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
1	1041C0700X	Clinical Social Worker	LCSW-564	WY

General Provider Information

NPI Number	:	1154339844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE LYNN NICOL LCSW

Provider Business Mailing Address
First Line	:	825 W PARK AVE
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-3353
Country	:	US
Telephone Number	:	307-217-0377
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 N 8TH ST W
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-2332
Country	:	US
Telephone Number	:	307-857-3111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	01/15/2024

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