Provider Demographics
NPI:1063953396
Name:DIPZINSKI, NICOLE RUTH (LICSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RUTH
Last Name:DIPZINSKI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 SW WATERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7147
Mailing Address - Country:US
Mailing Address - Phone:360-499-4535
Mailing Address - Fax:
Practice Address - Street 1:275 SE CABOT DR
Practice Address - Street 2:B206
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3715
Practice Address - Country:US
Practice Address - Phone:360-499-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 605425521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical