Provider Demographics
NPI:1366932824
Name:MICKELSON, NANCY L (LSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:MICKELSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 E GIRARD AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5508
Mailing Address - Country:US
Mailing Address - Phone:720-236-0762
Mailing Address - Fax:
Practice Address - Street 1:10200 E GIRARD AVE STE 222
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5508
Practice Address - Country:US
Practice Address - Phone:720-236-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW099263251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty