Provider Demographics
NPI:1447929054
Name:NICHOLS, LINDSAY D
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:D
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:D
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:729 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4030
Mailing Address - Country:US
Mailing Address - Phone:740-876-8290
Mailing Address - Fax:740-529-1205
Practice Address - Street 1:729 6TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4030
Practice Address - Country:US
Practice Address - Phone:740-876-8290
Practice Address - Fax:740-529-1205
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator