Provider Demographics
NPI:1598061210
Name:KNOWLES, NICOLE (LISW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:3320 W. 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-3200
Mailing Address - Country:US
Mailing Address - Phone:712-202-0777
Mailing Address - Fax:712-202-0780
Practice Address - Street 1:3320 W. 4TH STREET
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-3200
Practice Address - Country:US
Practice Address - Phone:712-202-0777
Practice Address - Fax:712-202-0780
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007074104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker