Provider Demographics
NPI:1497090492
Name:NICKISCHER, KATHRYN M (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:NICKISCHER
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 1:4797 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-9315
Mailing Address - Country:US
Mailing Address - Phone:484-895-8007
Mailing Address - Fax:
Practice Address - Street 1:1011 BROOKSIDE RD STE 302
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9042
Practice Address - Country:US
Practice Address - Phone:484-263-0197
Practice Address - Fax:267-627-9015
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional