Provider Demographics
NPI:1659000362
Name:PRANKE, NICHOLAS PETER (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PETER
Last Name:PRANKE
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 SHINGLE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2322
Mailing Address - Country:US
Mailing Address - Phone:763-569-5201
Mailing Address - Fax:763-569-5240
Practice Address - Street 1:5910 SHINGLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2322
Practice Address - Country:US
Practice Address - Phone:763-569-5201
Practice Address - Fax:763-569-5240
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN282671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical