Doctor Name: | SHANLEY SWANSON NICOLAI |
NPI Number: | 1326464397 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW LAC |
License Number: | 11582 |
Business Practice Address: | 126 6th Ave Sw Ronan, MT - 598642600 |
Business Phone Number: | 4066763600 |
Business Fax Number: | 4066763738 |
Mailing Address: | 1325 Wyoming St, MISSOULA |
State: | MT |
Postal Code: | 598011725 |
Phone Number: | 4065329862 |
Fax Number: | 4065413032 |
NPI Enumeration Date: | 03/13/2014 |
NPI Last Update Date: | 05/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 11582 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |