Provider Demographics
NPI:1013553346
Name:NICHOLSON, KRISTEN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2737
Mailing Address - Country:US
Mailing Address - Phone:414-940-7141
Mailing Address - Fax:
Practice Address - Street 1:N48W14336 HAMPTON RD STE 200
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-6941
Practice Address - Country:US
Practice Address - Phone:414-940-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7362-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health