Provider Demographics
NPI:1902213705
Name:FISHER, NICOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:GAUER PATNODE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5985 RICE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5038
Mailing Address - Country:US
Mailing Address - Phone:651-348-7240
Mailing Address - Fax:
Practice Address - Street 1:5985 RICE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5038
Practice Address - Country:US
Practice Address - Phone:651-348-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MN234651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical