Provider Demographics
NPI:1285908848
Name:BACHMAN, NICOLE ORELLA (LISW-S)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ORELLA
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ORELLA
Other - Last Name:PIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3848 BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5979
Mailing Address - Country:US
Mailing Address - Phone:440-785-0240
Mailing Address - Fax:
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-5015
Practice Address - Fax:330-543-7474
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.09013071041C0700X
OHI.12003611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical