Provider Demographics
NPI:1376390559
Name:NIELSEN, FAITH (MSW)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:ELIZABETH
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29742 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-6648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4230 S WESTNEDGE AVE STE 6
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3291
Practice Address - Country:US
Practice Address - Phone:928-278-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical