Provider Demographics
NPI:1275223182
Name:VANZUIDAM, NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:VANZUIDAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27080 379TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICA
Mailing Address - State:SD
Mailing Address - Zip Code:57328-5016
Mailing Address - Country:US
Mailing Address - Phone:605-680-4202
Mailing Address - Fax:
Practice Address - Street 1:610 E 7TH ST
Practice Address - Street 2:
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369
Practice Address - Country:US
Practice Address - Phone:605-337-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11519106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist