Provider Demographics
NPI:1093889792
Name:NIMKE, ANGELA CHRISTINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:NIMKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1100 E NORRIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3678
Mailing Address - Country:US
Mailing Address - Phone:815-433-3100
Mailing Address - Fax:815-431-5298
Practice Address - Street 1:1100 E NORRIS DRIVE
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-3678
Practice Address - Country:US
Practice Address - Phone:815-433-3100
Practice Address - Fax:815-431-5298
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490122211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical