Provider Demographics
NPI:1346888468
Name:NICKOL, PAIGE (LSW)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:NICKOL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1814
Mailing Address - Country:US
Mailing Address - Phone:937-818-9121
Mailing Address - Fax:937-222-0610
Practice Address - Street 1:141 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1814
Practice Address - Country:US
Practice Address - Phone:937-818-9121
Practice Address - Fax:937-222-0610
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.2208296104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker