Provider Demographics
NPI:1457084956
Name:FERGUSON, NIKKOLE CHRISTINE (MSW, SWLC)
Entity Type:Individual
Prefix:
First Name:NIKKOLE
Middle Name:CHRISTINE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MSW, SWLC
Other - Prefix:
Other - First Name:NIKKOLE
Other - Middle Name:
Other - Last Name:SKORUPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31596
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-1596
Mailing Address - Country:US
Mailing Address - Phone:406-672-6875
Mailing Address - Fax:
Practice Address - Street 1:2525 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9222
Practice Address - Country:US
Practice Address - Phone:406-672-6875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-495831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical