Provider Demographics
NPI:1013377803
Name:NELSON, NOAH FIELDEN (MSW, LLMSW)
Entity Type:Individual
Prefix:MR
First Name:NOAH
Middle Name:FIELDEN
Last Name:NELSON
Suffix:
Gender:M
Credentials:MSW, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 TWIN LAKES DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1453
Mailing Address - Country:US
Mailing Address - Phone:312-909-0135
Mailing Address - Fax:
Practice Address - Street 1:2307 TWIN LAKES DR APT 2A
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1453
Practice Address - Country:US
Practice Address - Phone:312-909-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801098361104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker