Provider Demographics
NPI:1457442253
Name:NIMS, WENDY MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MARIE
Last Name:NIMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 IRVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-4008
Mailing Address - Country:US
Mailing Address - Phone:909-544-0495
Mailing Address - Fax:
Practice Address - Street 1:240 IRVINGTON DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-4008
Practice Address - Country:US
Practice Address - Phone:909-544-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS204341041C0700X
ORL80681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical