Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicole Shannon Thull, SAC-IT

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1669962825

Nicole Shannon Thull, SAC-IT is an Addiction (Substance Use Disorder) Counselor in Kewaskum, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2018.

Licensed in
WI
In the registry since
2018

Practice location Address checks out

1421 Fond Du Lac Ave
Kewaskum, WI 53040-9136
Phone: (262) 626-4166
Fax: (262) 626-8431
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence 17291-130 (WI)

Record details

NPI number1669962825
Entity typeIndividual (Type 1)
GenderFemale
Credentials SAC-IT
Sole proprietorNo
NPI enumeratedMay 14, 2018
Last updated in NPPESMay 14, 2018

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