Provider Demographics
NPI:1609912559
Name:GIES, NICOLE HELENE (LCSW, RADC-I)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:HELENE
Last Name:GIES
Suffix:
Gender:F
Credentials:LCSW, RADC-I
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:HELENE
Other - Last Name:LAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW,RADC-I
Mailing Address - Street 1:N91W17271 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2045
Mailing Address - Country:US
Mailing Address - Phone:262-502-3300
Mailing Address - Fax:262-532-9585
Practice Address - Street 1:N91W17271 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2045
Practice Address - Country:US
Practice Address - Phone:262-502-3300
Practice Address - Fax:262-532-9585
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13989101YA0400X
WI7319-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43717400Medicaid