Individual
MS. NICHELLE D ROTHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY, MILWAUKEE, WI 53215-3669
(414) 385-1922
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
764-226
WI
103G00000X
Clinical Neuropsychologist
Primary
3383-57
WI
103T00000X
Psychologist
3383
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100059806
—
WI
Enumeration date
09/23/2009
Last updated
11/24/2025
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