| Doctor Name: | RICHARD DENNIS NICKISON |
| NPI Number: | 1386007078 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LSW |
| License Number: | S0027906 |
| Business Practice Address: | 418 Center St Wheelersburg, OH - 456941712 |
| Business Phone Number: | 7407762785 |
| Business Fax Number: | 7407762793 |
| Mailing Address: | 10352 State Route 139, JACKSON |
| State: | OH |
| Postal Code: | 456409361 |
| Phone Number: | 7405775775 |
| Fax Number: | 7402860245 |
| NPI Enumeration Date: | 03/31/2016 |
| NPI Last Update Date: | 03/31/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | S0027906 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |