Provider Demographics
NPI:1396861837
Name:NICHOLS, BOBBI JO MARIE (MSSW, APSW)
Entity Type:Individual
Prefix:
First Name:BOBBI JO
Middle Name:MARIE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7216 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2760
Mailing Address - Country:US
Mailing Address - Phone:608-347-4872
Mailing Address - Fax:
Practice Address - Street 1:619 RIVER ST
Practice Address - Street 2:SUITE F
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9117
Practice Address - Country:US
Practice Address - Phone:608-445-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43712900Medicaid