Healthcare Provider Details

I. General information

NPI: 1780205880
Provider Name (Legal Business Name): NICOLE VIKE LPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE PRIGAN

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 S 60TH ST
MILWAUKEE WI
53214-3369
US

IV. Provider business mailing address

7078 N PARKVIEW DR
LANNON WI
53046-9713
US

V. Phone/Fax

Practice location:
  • Phone: 414-510-0332
  • Fax:
Mailing address:
  • Phone: 414-510-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6950-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number17-222
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: