Provider Demographics
NPI:1447492566
Name:NIENABER, MELANNIE D (LCSW)
Entity type:Individual
Prefix:
First Name:MELANNIE
Middle Name:D
Last Name:NIENABER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:D
Other - Last Name:EHRLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2020 GRAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2679
Mailing Address - Country:US
Mailing Address - Phone:406-970-3759
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2679
Practice Address - Country:US
Practice Address - Phone:406-970-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8001041C0700X
MT381261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29338361Medicaid
CO022625OtherKAISER COMMERCIAL NUMBER
CO29338361Medicaid