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NPI Code Detail

MEDICARE: NICOLE I DIDIER LCSW

MEDICARE: NICOLE I DIDIER 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
11041C0700XClinical Social Worker149024566IL

General Provider Information

NPI Number : 1316686918
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE I DIDIER LCSW
Provider Business Mailing Address
First Line : 6735 VISTAGREEN WAY STE 210
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-5654
Country : US
Telephone Number : 402-601-8821
Fax Number :
Provider Business Practice Location Address
First Line : 6735 VISTAGREEN WAY STE 210
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-5654
Country : US
Telephone Number : 402-601-8821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2022
Last Update Date : 08/02/2023

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Directions to “ NICOLE I DIDIER LCSW” Practice Location

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