Provider Demographics
NPI:1548478662
Name:HEMBROOK, NICOLE L (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:HEMBROOK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:BROIHAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2225 HILLDALE CIR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-4678
Mailing Address - Country:US
Mailing Address - Phone:608-220-3929
Mailing Address - Fax:608-829-1885
Practice Address - Street 1:7633 GANSER WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2092
Practice Address - Country:US
Practice Address - Phone:608-829-1800
Practice Address - Fax:608-829-1885
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100005724Medicaid