Healthcare Provider Details

I. General information

NPI: 1962348441
Provider Name (Legal Business Name): NICOLE LYNN WHEATLEY PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 W HIGHLAND BLVD
MILWAUKEE WI
53208-3253
US

IV. Provider business mailing address

3223 W HIGHLAND BLVD
MILWAUKEE WI
53208-3253
US

V. Phone/Fax

Practice location:
  • Phone: 414-324-3482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: