Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicky Callicotte

Individual provider Case Manager/Care Coordinator · NPI 1205084845

Nicky Callicotte is a Clinical Social Worker in Sandy, Oregon. Qualified in 2014, 12 years ago. Practices with Legacy Clinics LLC, a 718-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
12
Licensed in
OR
In the registry since
2008
Specialties on file
2

Practice location Address checks out

36860 Industrial Way
Sandy, OR 97055-7371
Phone: (503) 826-0206
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 847 Ne 19th Ave, Portland, OR 97232-2684 — (503) 552-6203

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence L11089 (OR)
Case Manager/Care Coordinator Taxonomy 171M00000X

Record details

NPI number1205084845
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 8, 2008
Last updated in NPPESJune 6, 2024
Certification dateJune 6, 2024
Mailing addressPo Box 3777, Portland, OR 97208-3777

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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