MEDICARE: NICOLENA HENSLER-GORDON LPC

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	6471-125	WI

General Provider Information

NPI Number	:	1881128445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLENA HENSLER-GORDON LPC

Provider Business Mailing Address
First Line	:	414 E WALNUT ST STE 140
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-5019
Country	:	US
Telephone Number	:	920-772-8711
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 E WALNUT ST STE 140
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-5019
Country	:	US
Telephone Number	:	920-772-8711
Fax Number	:

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

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	09/07/2025

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