Provider Demographics
NPI:1902421092
Name:AGUILERA TORRES, NICHOLE MARGARET (LICSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARGARET
Last Name:AGUILERA TORRES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:NICHOLE
Other - Middle Name:MARGARET
Other - Last Name:BUDAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14949 62ND ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6102
Mailing Address - Country:US
Mailing Address - Phone:651-430-4199
Mailing Address - Fax:
Practice Address - Street 1:14949 62ND ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6102
Practice Address - Country:US
Practice Address - Phone:651-430-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical