Provider Demographics
NPI:1902086168
Name:NIELSON, GORDON E (LICSW)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:E
Last Name:NIELSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520-B ROCK ISLAND RD.
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802
Mailing Address - Country:US
Mailing Address - Phone:509-470-8544
Mailing Address - Fax:509-470-8544
Practice Address - Street 1:2520B ROCK ISLAND RD
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5844
Practice Address - Country:US
Practice Address - Phone:509-470-8544
Practice Address - Fax:509-470-8544
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000095991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical