Provider Demographics
NPI:1942973102
Name:KLOMP, NICOLE M (LLMSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:KLOMP
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8964 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-8087
Mailing Address - Country:US
Mailing Address - Phone:616-648-3189
Mailing Address - Fax:
Practice Address - Street 1:232 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-9631
Practice Address - Country:US
Practice Address - Phone:231-652-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty