Individual
JENNIFER A NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT, SAC
Contact information
Practice address
200 MASON ST STE 11, ONALASKA, WI 54650-7061
(608) 769-6784
Mailing address
200 MASON STREET, SUITE 11, ONALASKA, WI 54650
(608) 769-6784
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16360-131
WI
101YP2500X
Professional Counselor
Primary
4346-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4346-226
STATE OF WISCONSIN
WI
Enumeration date
12/13/2019
Last updated
03/01/2020
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