Provider Demographics
NPI:1790080638
Name:RITLAND, NICOLE RENAE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RENAE
Last Name:RITLAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4962 STREAM SIDE CIR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-5116
Mailing Address - Country:US
Mailing Address - Phone:515-263-2027
Mailing Address - Fax:
Practice Address - Street 1:600 42ND ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2701
Practice Address - Country:US
Practice Address - Phone:515-255-8399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker