Provider Demographics
NPI:1750621504
Name:RICHARDSON, NANCY (MSE, LPC, CSAC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSE, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 KADLEC DR
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6627
Mailing Address - Country:US
Mailing Address - Phone:608-728-2090
Mailing Address - Fax:
Practice Address - Street 1:2627 KADLEC DR
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6627
Practice Address - Country:US
Practice Address - Phone:608-728-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15560-132101YA0400X
WI7207-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)