Provider Demographics
NPI:1710772710
Name:PAGENKOPF, NICOLE (MA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PAGENKOPF
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HERITAGE DR APT 11
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-9120
Mailing Address - Country:US
Mailing Address - Phone:715-937-7898
Mailing Address - Fax:
Practice Address - Street 1:1480 COUNTY ROAD XX
Practice Address - Street 2:
Practice Address - City:ROTHSCHILD
Practice Address - State:WI
Practice Address - Zip Code:54474-9003
Practice Address - Country:US
Practice Address - Phone:715-489-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst