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NPI Code Detail

MEDICARE: NICOLE WALDECK LPCC, LPAT

MEDICARE: NICOLE WALDECK LPCC, LPAT
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
1101YP2500XProfessional CounselorE.2606235OH
2101YP2500XProfessional CounselorC.2204408OH
3221700000XArt Therapist23-166
4101YP2500XProfessional CounselorC.2103251-TRNEOH
5221700000XArt TherapistART25000006OH
6101Y00000XCounselorC.2204408OH

General Provider Information

NPI Number : 1902478753
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE WALDECK LPCC, LPAT
Provider Business Mailing Address
First Line : 5209 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-2224
Country : US
Telephone Number : 216-651-2037
Fax Number :
Provider Business Practice Location Address
First Line : 5209 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-2224
Country : US
Telephone Number : 216-323-6902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2021
Last Update Date : 01/21/2026

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Directions to “ NICOLE WALDECK LPCC, LPAT” Practice Location

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