Provider Demographics
NPI:1609217942
Name:BICKNELL, NANCY K (LPC SAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:LPC SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-0131
Mailing Address - Country:US
Mailing Address - Phone:920-261-2199
Mailing Address - Fax:
Practice Address - Street 1:104 N 1ST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3754
Practice Address - Country:US
Practice Address - Phone:920-261-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11437-131101YA0400X
WI3034-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)