Provider Demographics
NPI:1053577114
Name:ORDWAY, NIKOLE MARIE IV
Entity type:Individual
Prefix:
First Name:NIKOLE
Middle Name:MARIE
Last Name:ORDWAY
Suffix:IV
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 1:3082 GRIZZLY PEAK DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8546
Mailing Address - Country:US
Mailing Address - Phone:303-717-9884
Mailing Address - Fax:
Practice Address - Street 1:3082 GRIZZLY PEAK DR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8546
Practice Address - Country:US
Practice Address - Phone:303-717-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COCSW.099255411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health