Provider Demographics
NPI:1578606737
Name:HILDEBRANDT, NICOLE L (MSSW LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:HILDEBRANDT
Suffix:
Gender:F
Credentials:MSSW LICSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:GOUGEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSSW LICSW
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6741
Practice Address - Country:US
Practice Address - Phone:952-993-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72981231041C0700X
MN219931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical