Provider Demographics
NPI:1417971417
Name:CHEREK, NICOLE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CHEREK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:NAVARRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1813
Mailing Address - Country:US
Mailing Address - Phone:262-284-8200
Mailing Address - Fax:262-284-8104
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1813
Practice Address - Country:US
Practice Address - Phone:262-284-8200
Practice Address - Fax:262-284-8104
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6542-120104100000X
WI3238-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40932300Medicaid