Johnson, Nicole Rene

Johnson, Nicole Rene is an sole proprietor health care provider with primary practice located at 704 Sand Lake Rd Ste 105 , Onalaska WI 54650-2456. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Johnson, Nicole Rene can be contacted via phone (608) 799-3881.

Contact Information

Primary practice address
704 Sand Lake Rd Ste 105 Onalaska WI 54650-2456
Phone: (608) 799-3881
Fax: (608) 440-2823
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 15560-131 Wisconsin
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 3067-125 Wisconsin

Profile Details

NPI number 1689616518
LBN Legal business name Johnson, Nicole Rene
Credentials M.S., L.P.C., S.A.C.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 12th, 2006
Last updated Mar 30th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689616518 NPPES
Wisconsin MEDICAID 40907500

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