Provider Demographics
NPI:1740567130
Name:HOWARD, NICOLETTE DANIELLE
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:DANIELLE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2268 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1556
Mailing Address - Country:US
Mailing Address - Phone:219-923-5876
Mailing Address - Fax:
Practice Address - Street 1:30 E HURON ST APT 1106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2787
Practice Address - Country:US
Practice Address - Phone:847-997-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst