Provider Demographics
NPI:1013489434
Name:IMHOF, NICOLE ROSE (LICSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSE
Last Name:IMHOF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ROSE
Other - Last Name:GIAMBALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-293-6984
Mailing Address - Fax:507-284-5745
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-293-6984
Practice Address - Fax:507-284-5745
Is Sole Proprietor?:No
Enumeration Date:2018-12-24
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical