Provider Demographics
NPI:1194759233
Name:NORDEEN, MONICA L (LMSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:NORDEEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 LONGYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2115
Mailing Address - Country:US
Mailing Address - Phone:906-250-0933
Mailing Address - Fax:
Practice Address - Street 1:1720 LONGYEAR AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2115
Practice Address - Country:US
Practice Address - Phone:906-250-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010772211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN21670024Medicare ID - Type Unspecified