| Doctor Name: | NIKKI WAIT |
| NPI Number: | 1124491113 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 304087 |
| Business Practice Address: | 100 17th Ave Nw Ste 2 Glenwood, MN - 563342159 |
| Business Phone Number: | 3206343446 |
| Business Fax Number: | 3206340384 |
| Mailing Address: | 100 17th Ave Nw, Ste 2 GLENWOOD |
| State: | MN |
| Postal Code: | 563342159 |
| Phone Number: | 3206343446 |
| Fax Number: | 3206340384 |
| NPI Enumeration Date: | 11/12/2015 |
| NPI Last Update Date: | 11/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 304087 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |