Healthcare Provider Details

I. General information

NPI: 1013553346
Provider Name (Legal Business Name): KRISTEN NICHOLSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 W WELLS ST
MILWAUKEE WI
53233-1920
US

IV. Provider business mailing address

1308 N 45TH ST
MILWAUKEE WI
53208-2737
US

V. Phone/Fax

Practice location:
  • Phone: 414-312-7070
  • Fax:
Mailing address:
  • Phone: 414-940-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7362-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7362-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: