Healthcare Provider Details

I. General information

NPI: 1750621504
Provider Name (Legal Business Name): NANCY RICHARDSON MSE, LPC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 KADLEC DR
BELOIT WI
53511-6627
US

IV. Provider business mailing address

2627 KADLEC DR
BELOIT WI
53511-6627
US

V. Phone/Fax

Practice location:
  • Phone: 608-728-2090
  • Fax:
Mailing address:
  • Phone: 608-728-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7207-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7207-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15560-132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: