Provider Demographics
NPI:1093541203
Name:KATHERINE NICOLARSEN, LLC
Entity type:Organization
Organization Name:KATHERINE NICOLARSEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LCSW, LADC
Authorized Official - Phone:402-215-9220
Mailing Address - Street 1:11840 NICHOLAS ST STE 205
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4475
Mailing Address - Country:US
Mailing Address - Phone:402-215-9220
Mailing Address - Fax:
Practice Address - Street 1:11840 NICHOLAS ST STE 205
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4475
Practice Address - Country:US
Practice Address - Phone:402-215-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty