Provider Demographics
NPI:1801555438
Name:CLAESON, NICOLE HOWARD (LICSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:HOWARD
Last Name:CLAESON
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 1:5028 GLADSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1325
Mailing Address - Country:US
Mailing Address - Phone:612-770-4422
Mailing Address - Fax:612-672-2691
Practice Address - Street 1:3400 W 66TH ST STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2134
Practice Address - Country:US
Practice Address - Phone:612-672-6999
Practice Address - Fax:612-672-2691
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN286361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical