Individual
MRS. PAMELA JANE NIKODEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, SAC-T
Contact information
Practice address
812 S FISK ST STE 103104, GREEN BAY, WI 54304-2269
(920) 404-4638
Mailing address
812 S FISK ST STE 103104, GREEN BAY, WI 54304-2269
(920) 404-4638
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19515-130
WI
101YP2500X
Professional Counselor
Primary
11238-125
WI
101YP2500X
Professional Counselor
5078-226
WI
Other
Enumeration date
12/08/2021
Last updated
09/03/2024
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