Individual
NICOLE L. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC, ICS, LPC-IT
Contact information
Practice address
6815 W CAPITOL DR STE 304, MILWAUKEE, WI 53216-2056
(414) 604-6488
Mailing address
6815 W CAPITOL DR STE 304, MILWAUKEE, WI 53216-2056
(414) 604-6488
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
15477-135
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
15137-132
WI
101YM0800X
Mental Health Counselor
638-226
WI
101YP2500X
Professional Counselor
Primary
7520-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39175900
—
WI
Enumeration date
06/04/2008
Last updated
08/29/2025
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