MEDICARE: NICOLE ANN POTTER 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	149026195	IL
2	1041C0700X	Clinical Social Worker	TPSW5597	FL
3	1041C0700X	Clinical Social Worker	5720C	AL
4	1041C0700X	Clinical Social Worker	0904016668	VA
5	1041C0700X	Clinical Social Worker	34010561A	IN

General Provider Information

NPI Number	:	1841071735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ANN POTTER LCSW

Provider Business Mailing Address
First Line	:	201 N OXFORD ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N OXFORD ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3329
Country	:	US
Telephone Number	:	317-966-2242
Fax Number	:

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

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	03/09/2026

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