Provider Demographics
NPI:1649437419
Name:SCALES LINDBERG, NICOLE SUSAN (LICSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUSAN
Last Name:SCALES LINDBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 B MAPLE HILLS DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2865
Mailing Address - Country:US
Mailing Address - Phone:651-485-8457
Mailing Address - Fax:
Practice Address - Street 1:715 B MAPLE HILLS DRIVE EAST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55117-2865
Practice Address - Country:US
Practice Address - Phone:651-485-8457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171400000X
MN154821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach