Provider Demographics
NPI:1417705278
Name:NICKEL, JANIE LEE (BSW)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:LEE
Last Name:NICKEL
Suffix:
Gender:X
Credentials:BSW
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:NICKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSW
Mailing Address - Street 1:2941 OLDEN OAK LN APT 303
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2174
Mailing Address - Country:US
Mailing Address - Phone:614-395-8357
Mailing Address - Fax:
Practice Address - Street 1:22170 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6007
Practice Address - Country:US
Practice Address - Phone:248-372-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator