Provider Demographics
NPI:1750741013
Name:FLANNERY, NICOLE (MS, CSAC, LPC, ICS-I)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:MS, CSAC, LPC, ICS-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 LANDER LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-4612
Mailing Address - Country:US
Mailing Address - Phone:414-232-7818
Mailing Address - Fax:
Practice Address - Street 1:217 WISCONSIN AVE STE 202
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4946
Practice Address - Country:US
Practice Address - Phone:414-301-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15975-132101YA0400X
WI10001-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)