Provider Demographics
NPI:1316132525
Name:NOLL, CHERYLYNN NMI (BS, CSAC, CSIT)
Entity type:Individual
Prefix:
First Name:CHERYLYNN
Middle Name:NMI
Last Name:NOLL
Suffix:
Gender:F
Credentials:BS, CSAC, CSIT
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:
Other - Last Name:NOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, CSAC, CSIT
Mailing Address - Street 1:W193N16123 STONEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9525
Mailing Address - Country:US
Mailing Address - Phone:262-305-0104
Mailing Address - Fax:
Practice Address - Street 1:2814 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-3224
Practice Address - Country:US
Practice Address - Phone:414-885-3525
Practice Address - Fax:262-643-4617
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15378-131101YA0400X
WI17039-133101YA0400X
WI16638-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)