Provider Demographics
NPI:1306992490
Name:NICHOLAS, WENDY K (LSW)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:K
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:K
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:534 DIETZ RD
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-7824
Mailing Address - Country:US
Mailing Address - Phone:570-524-9477
Mailing Address - Fax:570-322-8029
Practice Address - Street 1:1800 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1236
Practice Address - Country:US
Practice Address - Phone:570-524-9477
Practice Address - Fax:570-322-8029
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125646104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker