Provider Demographics
NPI:1881280121
Name:VANDERHOOF, NICOLE LEIGH (MA, LPCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEIGH
Last Name:VANDERHOOF
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-7308
Mailing Address - Country:US
Mailing Address - Phone:507-990-1908
Mailing Address - Fax:
Practice Address - Street 1:2121 CAMPUS DR SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4744
Practice Address - Country:US
Practice Address - Phone:507-322-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health