Provider Demographics
NPI:1184381055
Name:WIEK, NYCOLE LYNN (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:NYCOLE
Middle Name:LYNN
Last Name:WIEK
Suffix:
Gender:F
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 1:13700 MEADOW ACRES PL
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4511
Mailing Address - Country:US
Mailing Address - Phone:612-258-1523
Mailing Address - Fax:
Practice Address - Street 1:11090 183RD CIR NW STE C
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2884
Practice Address - Country:US
Practice Address - Phone:763-333-8001
Practice Address - Fax:651-925-0267
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN712491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical