Mary Katherine Nissen, LCSW
Social Worker, Clinical in Ronan, MT. Individual provider (NPI-1).
NPI number1760735682
StatusActive
Last updated in NPPESDec 1, 2023
Details
- NPI
- 1760735682
- Entity type
- Individual (NPI-1)
- Name
- Mary Katherine Nissen
- Credential
- LCSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 16, 2012
- Certification date
- Dec 1, 2023
- Last updated
- Dec 1, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 66438 | MT | Yes |
| 1041C0700X | Social Worker, Clinical | 189560 | AK | |
| 104100000X | Social Worker | – | – |
Practice location
407 Main St SwRonan, MT 59864-2710
Phone 406-210-8831
Mailing address
Po Box 528Bethel, AK 99559
Phone 907-543-6100 · Fax 907-543-6008
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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