MEDICARE: NICHOLAS SALAZAR LPC, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10389-125	WI
2	101YM0800X	Mental Health Counselor	10389-125	WI

General Provider Information

NPI Number	:	1619660065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS SALAZAR LPC, MS

Provider Business Mailing Address
First Line	:	2582 N CRAMER ST APT 4
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3990
Country	:	US
Telephone Number	:	262-664-3514
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 N GREEN BAY AVE STE 205
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-4446
Country	:	US
Telephone Number	:	262-789-1191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	01/20/2026

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