Provider Demographics
NPI:1003626185
Name:PLANTE, NICHOLAS (LADC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PLANTE
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 RIVER VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-5302
Mailing Address - Country:US
Mailing Address - Phone:612-501-7897
Mailing Address - Fax:
Practice Address - Street 1:2142 RIVER VALLEY LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-5302
Practice Address - Country:US
Practice Address - Phone:612-501-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN307119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)