Provider Demographics
NPI:1861563678
Name:NICOL, HEATHER (LISW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:NICOL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-2282
Mailing Address - Country:US
Mailing Address - Phone:419-496-2278
Mailing Address - Fax:419-496-2287
Practice Address - Street 1:19 W MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-2282
Practice Address - Country:US
Practice Address - Phone:419-496-2278
Practice Address - Fax:419-496-2287
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00088441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical