Provider Demographics
NPI:1619337144
Name:WICKLUND, NICOLE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WICKLUND
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-4726
Mailing Address - Country:US
Mailing Address - Phone:651-434-9233
Mailing Address - Fax:
Practice Address - Street 1:4510 77TH ST W
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5505
Practice Address - Country:US
Practice Address - Phone:651-434-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist