Provider Demographics
NPI:1366751497
Name:NICHOLS, SHERRIE LYNN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:LYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:SHERRIE
Other - Middle Name:LYNN
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2012
Mailing Address - Country:US
Mailing Address - Phone:715-258-6353
Mailing Address - Fax:715-258-6409
Practice Address - Street 1:811 HARDING ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2012
Practice Address - Country:US
Practice Address - Phone:715-258-6353
Practice Address - Fax:715-258-6409
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI856-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1366751497Medicaid