Provider Demographics
NPI:1376275511
Name:NYGAARD, MALLORY (LCSW)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:NYGAARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-8875
Mailing Address - Country:US
Mailing Address - Phone:701-471-2098
Mailing Address - Fax:
Practice Address - Street 1:2700 STATE ST # 5
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0669
Practice Address - Country:US
Practice Address - Phone:701-200-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND54691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical