Individual
NICOLE D MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
505 BROADWAY ST, BARABOO, WI 53913-2183
(608) 355-4200
Mailing address
505 BROADWAY ST, BARABOO, WI 53913-2183
(608) 355-4200
(608) 355-4299
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
18081-130
WI
101YM0800X
Mental Health Counselor
Primary
7855-125
WI
Other
Enumeration date
01/22/2019
Last updated
09/26/2023
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