1710946835 NPI number — MS. NANCY ANN TRICKEY LICSW

Table of content: MS. NANCY ANN TRICKEY LICSW (NPI 1710946835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710946835 NPI number — MS. NANCY ANN TRICKEY LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRICKEY
Provider First Name:
NANCY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWENSON
Provider Other First Name:
NANCY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710946835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 BRUCE ST
Provider Second Line Business Mailing Address:
PO BOX 603
Provider Business Mailing Address City Name:
CROOKSTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56716-0603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-281-3940
Provider Business Mailing Address Fax Number:
218-281-6261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 BRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROOKSTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56716-0603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-281-3940
Provider Business Practice Location Address Fax Number:
218-281-6261
Provider Enumeration Date:
03/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  14112 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HP37877 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20306 . This is a "BCBS OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 54B78TR . This is a "BCBS BHSI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 150865 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1033531 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".




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