Provider Demographics
NPI:1780205880
Name:VIKE, NICOLE (LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:VIKE
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:PRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7078 N PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LANNON
Mailing Address - State:WI
Mailing Address - Zip Code:53046-9713
Mailing Address - Country:US
Mailing Address - Phone:414-510-0332
Mailing Address - Fax:
Practice Address - Street 1:932 S 60TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3369
Practice Address - Country:US
Practice Address - Phone:414-510-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17-222221700000X
WI6950-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist