Individual provider · Type 1 NPI
Nicole Shannon Thull, SAC-IT
Addiction (Substance Use Disorder) Counselor · Kewaskum, WI
NPI number
1669962825
Active
Practice location
1421 Fond Du Lac Ave
Kewaskum, WI 53040-9136
Fax (262) 626-8431
Mailing address
9349 Windy Acres Dr
Kewaskum, WI 53040-9742
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 17291-130 (WI) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
3 other providers at this address
Other addiction (substance use disorder) counselor providers in Kewaskum
About NPI 1669962825
Nicole Shannon Thull, SAC-IT's National Provider Identifier is 1669962825, issued on May 14, 2018. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Kewaskum, WI. The record was last updated on May 14, 2018.