Provider Demographics
NPI:1639560204
Name:STEFFEN, NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 776974
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6974
Mailing Address - Country:US
Mailing Address - Phone:231-672-2119
Mailing Address - Fax:
Practice Address - Street 1:7782 20TH AVE
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428
Practice Address - Country:US
Practice Address - Phone:616-685-8700
Practice Address - Fax:616-457-5567
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011039071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical