Provider Demographics
NPI:1568931194
Name:NICKERSON, BRITTANY (BEHAVIOR ANALYST)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 31 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5772
Mailing Address - Country:US
Mailing Address - Phone:970-549-2303
Mailing Address - Fax:
Practice Address - Street 1:543 31 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-5772
Practice Address - Country:US
Practice Address - Phone:970-549-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-20-41548103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst