Provider Demographics
NPI:1942472790
Name:CONLON, NICOLE MARIE (PHD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:CONLON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:BAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5019 NICHOLS PL
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203
Mailing Address - Country:US
Mailing Address - Phone:425-387-0225
Mailing Address - Fax:415-412-3960
Practice Address - Street 1:19217 36TH AVE W
Practice Address - Street 2:SUITE 215
Practice Address - City:LYNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-753-5001
Practice Address - Fax:425-412-3960
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WAPY60067488103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist