Healthcare Provider Details

I. General information

NPI: 1215413646
Provider Name (Legal Business Name): NICOLE DAMROW MSE, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE PHILLIPS LPC-IT

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W LAWRENCE ST STE 320
APPLETON WI
54911-5754
US

IV. Provider business mailing address

100 W LAWRENCE ST STE 320
APPLETON WI
54911-5754
US

V. Phone/Fax

Practice location:
  • Phone: 920-241-3498
  • Fax:
Mailing address:
  • Phone: 920-241-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7847-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7847-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: