Provider Demographics
NPI:1588878276
Name:CROUNSE, NICOLE ANGELA (CSAC, LPC, ICS)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANGELA
Last Name:CROUNSE
Suffix:
Gender:F
Credentials:CSAC, LPC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 SCENIC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-2265
Mailing Address - Country:US
Mailing Address - Phone:608-658-7361
Mailing Address - Fax:
Practice Address - Street 1:2445 DARWIN RD STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3116
Practice Address - Country:US
Practice Address - Phone:608-658-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15283101YA0400X
WI5884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42025400Medicaid