Provider Demographics
NPI:1730645920
Name:XIONG, NANCY (LPC-IT, ATR-P)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:LPC-IT, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 N IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4906
Mailing Address - Country:US
Mailing Address - Phone:414-269-1886
Mailing Address - Fax:
Practice Address - Street 1:5235 N IRONWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4906
Practice Address - Country:US
Practice Address - Phone:414-269-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4011-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional