Provider Demographics
NPI:1497285258
Name:CLEMENT, NICOLE A (CSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 DAYSPRING COURT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4257
Mailing Address - Country:US
Mailing Address - Phone:270-498-9390
Mailing Address - Fax:
Practice Address - Street 1:1336 DAYSPRING COURT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4257
Practice Address - Country:US
Practice Address - Phone:270-498-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2525741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical