Provider Demographics
NPI:1225520851
Name:RIEKE, NICOLE ANN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:RIEKE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2873 MISSISSIPPI SHORES CIR
Mailing Address - Street 2:
Mailing Address - City:FORT RIPLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56449-1492
Mailing Address - Country:US
Mailing Address - Phone:218-851-0905
Mailing Address - Fax:
Practice Address - Street 1:201 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3902
Practice Address - Country:US
Practice Address - Phone:218-454-3845
Practice Address - Fax:218-454-3848
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical