Provider Demographics
NPI:1992126858
Name:NICOLET, STEPHANIE T (MS,MFT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:T
Last Name:NICOLET
Suffix:
Gender:F
Credentials:MS,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 TECHNOLOGY DR E
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2370
Mailing Address - Country:US
Mailing Address - Phone:715-235-4245
Mailing Address - Fax:715-235-4421
Practice Address - Street 1:402 TECHNOLOGY DR E
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2370
Practice Address - Country:US
Practice Address - Phone:715-235-4245
Practice Address - Fax:715-235-4421
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist