Provider Demographics
NPI:1750736534
Name:PETERSEN, NICOLE REED (MSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:REED
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S BURLINGTON AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6960
Mailing Address - Country:US
Mailing Address - Phone:402-463-7711
Mailing Address - Fax:
Practice Address - Street 1:835 S BURLINGTON AVE
Practice Address - Street 2:STE 108
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6960
Practice Address - Country:US
Practice Address - Phone:402-463-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10838101YM0800X
NE70571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health