Provider Demographics
NPI:1942199245
Name:NICHOLSON, NATALIE G
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:G
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2518
Mailing Address - Country:US
Mailing Address - Phone:978-886-3280
Mailing Address - Fax:
Practice Address - Street 1:1000 SHELARD PKWY STE 520
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4932
Practice Address - Country:US
Practice Address - Phone:952-224-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist