Provider Demographics
NPI:1922146281
Name:NIKOLAY, CHARITY ANN (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:ANN
Last Name:NIKOLAY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MISS
Other - First Name:CHARITY
Other - Middle Name:ANN
Other - Last Name:JUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:D3305 BANGART RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54484-9201
Mailing Address - Country:US
Mailing Address - Phone:715-486-1216
Mailing Address - Fax:
Practice Address - Street 1:901 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4718
Practice Address - Country:US
Practice Address - Phone:715-848-5022
Practice Address - Fax:888-778-6750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3727-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43701100Medicaid