Provider Demographics
NPI:1003086505
Name:NELSON, K. ROBIN NEWCOMBE (LADC, LICSW)
Entity Type:Individual
Prefix:
First Name:K. ROBIN
Middle Name:NEWCOMBE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LADC, LICSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ROBIN
Other - Last Name:NEWCOMBE NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC, LICSW
Mailing Address - Street 1:400 TIMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2754
Mailing Address - Country:US
Mailing Address - Phone:952-882-9320
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4752
Practice Address - Country:US
Practice Address - Phone:507-625-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN182271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical