Provider Demographics
NPI:1205581683
Name:PLYS, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:PLYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-6716
Mailing Address - Country:US
Mailing Address - Phone:218-340-9766
Mailing Address - Fax:
Practice Address - Street 1:2827 CHAMBERSBURG AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3004
Practice Address - Country:US
Practice Address - Phone:218-340-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28612104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker