Individual
MS. NICOLE VIENNA GUSTAFSON-BINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
4109 67TH ST, KENOSHA, WI 53142-3836
(262) 652-9830
Mailing address
5606 EAGLE POINT DR, RACINE, WI 53406-1181
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4197-125
WI
Other
Enumeration date
08/02/2009
Last updated
08/02/2009
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