Healthcare Provider Details

I. General information

NPI: 1629998380
Provider Name (Legal Business Name): NICKOLE BECKER LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 BARTON AVE
WEST BEND WI
53090-2029
US

IV. Provider business mailing address

1615 BARTON AVE
WEST BEND WI
53090-2029
US

V. Phone/Fax

Practice location:
  • Phone: 715-842-9500
  • Fax: 715-848-0425
Mailing address:
  • Phone: 715-842-9500
  • Fax: 715-848-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8596-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: