Healthcare Provider Details

I. General information

NPI: 1740121532
Provider Name (Legal Business Name): NICOLE HENDRYX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 WINNEBAGO ST
MADISON WI
53704-5314
US

IV. Provider business mailing address

4508 OAK VALLEY RD
CROSS PLAINS WI
53528-9322
US

V. Phone/Fax

Practice location:
  • Phone: 608-244-4859
  • Fax:
Mailing address:
  • Phone: 972-979-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: