Provider Demographics
NPI:1740705441
Name:BROCKEL-GANDSEY, NIKKI J (MSW, ACSW)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:J
Last Name:BROCKEL-GANDSEY
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:J
Other - Last Name:BROCKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7071 E DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93737-9220
Mailing Address - Country:US
Mailing Address - Phone:559-317-7729
Mailing Address - Fax:
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-353-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical