Provider Demographics
NPI:1831474048
Name:NUESSE, TOMMIE DICK (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:TOMMIE
Middle Name:DICK
Last Name:NUESSE
Suffix:
Gender:M
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27679 BLACK FOREST PASS
Mailing Address - Street 2:
Mailing Address - City:RANDALL
Mailing Address - State:MN
Mailing Address - Zip Code:56475-2156
Mailing Address - Country:US
Mailing Address - Phone:218-251-1868
Mailing Address - Fax:
Practice Address - Street 1:27679 BLACK FOREST PASS
Practice Address - Street 2:
Practice Address - City:RANDALL
Practice Address - State:MN
Practice Address - Zip Code:56475-2156
Practice Address - Country:US
Practice Address - Phone:218-251-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20209104100000X
MN1041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)