Healthcare Provider Details

I. General information

NPI: 1538071857
Provider Name (Legal Business Name): NICOLE LYNNE NORRIS MS, MFT-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 INTERNATIONAL LN STE 207
MADISON WI
53704-3152
US

IV. Provider business mailing address

5318 HOBOKEN RD
MADISON WI
53713-3706
US

V. Phone/Fax

Practice location:
  • Phone: 608-520-6207
  • Fax:
Mailing address:
  • Phone: 608-886-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1231-228
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: