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NPI Code Detail

MEDICARE: MRS. LAURA NICKLIN

MEDICARE: MRS. LAURA NICKLIN
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 Worker

General Provider Information

NPI Number : 1437932258
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA NICKLIN
Provider Business Mailing Address
First Line : 108 PALMETTO PARK BLVD STE D
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-7969
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 801 GERVAIS ST STE 2B
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-3125
Country : US
Telephone Number : 803-881-6714
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2023
Last Update Date : 04/13/2024

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Directions to “ MRS. LAURA NICKLIN ” Practice Location

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