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General NPI Number Information
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NPI Number | 1689616518
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Entity Type | Individual
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Provider Name | NICOLE RENE JOHNSON M.S., L.P.C., S.A.C.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 704 SAND LAKE RD STE 105
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City | ONALASKA
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State | WI
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Zip | 54650-2456
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Country | US
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Telephone | 608-799-3881
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Fax | 608-440-2823
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Provider Business Mailing Address
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Address Line | 704 SAND LAKE RD STE 105
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City | ONALASKA
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State | WI
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Zip | 54650-2456
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Country | US
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Telephone | 608-799-3881
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Fax | 608-440-2823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15560-131
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3067-125
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License Number State | WI
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