Bredeson, Nicky Diane

Bredeson, Nicky Diane is an individual health care provider with primary practice located at 4005 West 65Th St #108, Edina MN 55435-1700. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Bredeson, Nicky Diane can be contacted via phone (952) 929-1819.

Contact Information

Primary practice address
4005 West 65Th St #108 Edina MN 55435-1700
Phone: (952) 929-1819
Fax: (952) 929-0022
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X L.I.C.S.W. 257 Minnesota
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X L.M.F.T.564 Minnesota

Profile Details

NPI number 1487717344
LBN Legal business name Bredeson, Nicky Diane
Credentials LICSW LMFT
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 19th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487717344 NPPES
Minnesota Other LICSW257 LICENSE NUMBER
Minnesota Other LMFT564 LICENSE NUMBER

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