Provider Demographics
NPI:1518851526
Name:NICKERSON, CAILA FITTS (SWAIC)
Entity type:Individual
Prefix:
First Name:CAILA
Middle Name:FITTS
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:SWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2929
Mailing Address - Country:US
Mailing Address - Phone:781-558-3653
Mailing Address - Fax:781-558-3653
Practice Address - Street 1:912 22ND AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2929
Practice Address - Country:US
Practice Address - Phone:781-558-3653
Practice Address - Fax:781-558-3653
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC607043881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty