Provider Demographics
NPI:1073498531
Name:WHITLOCK, NICHOLE ELIZABETH
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ELIZABETH
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-1646
Mailing Address - Country:US
Mailing Address - Phone:507-441-5914
Mailing Address - Fax:
Practice Address - Street 1:1701 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4895
Practice Address - Country:US
Practice Address - Phone:507-565-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician