Provider Demographics
NPI:1760546220
Name:SLATER, NICKIE RENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICKIE
Middle Name:RENE
Last Name:SLATER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NICKIE
Other - Middle Name:RENE
Other - Last Name:LUDEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4102 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1851
Mailing Address - Country:US
Mailing Address - Phone:402-444-7931
Mailing Address - Fax:402-444-6338
Practice Address - Street 1:4102 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1851
Practice Address - Country:US
Practice Address - Phone:402-444-7931
Practice Address - Fax:402-444-6338
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEBSW171M00000X
NE40061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator