Provider Demographics
NPI:1689723090
Name:KOLAAS, NANCY LEE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEE
Last Name:KOLAAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 CAMPUS DRIVE SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904
Mailing Address - Country:US
Mailing Address - Phone:507-287-2243
Mailing Address - Fax:507-287-2371
Practice Address - Street 1:2116 CAMPUS DRIVE SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904
Practice Address - Country:US
Practice Address - Phone:507-287-2243
Practice Address - Fax:507-287-2371
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1444104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker