Active NPI
Dr Nicoles Online Therapy, Inc
- Psychologist
- West Bend, WI
National Provider Identifier
1033029491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Legal business name
- DR NICOLES ONLINE THERAPY, INC
- Doing business as
- Mommas Pedestal
- Practice address
- 2208 Skyline Dr
West Bend, WI 53090-1143 - Phone
- (414) 232-7277
- NPI assigned
- Sep 9, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Nicole Smith, PSYD
- Title
- Owner
- Phone
- (414) 232-7277
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
2208 Skyline Dr
West Bend, WI 53090-1143
Mailing address
PO Box 434
Slinger, WI 53086-0434
Phone (414) 232-7277
Other names 1
- Mommas Pedestal
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788912000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788912000000",
"number": "1033029491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 434",
"city": "SLINGER",
"state": "WI",
"postal_code": "530860434",
"telephone_number": "414-232-7277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2208 SKYLINE DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530901143",
"telephone_number": "414-232-7277"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DR NICOLES ONLINE THERAPY, INC",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-09",
"last_updated": "2026-09-09",
"certification_date": "2026-09-09",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "NICOLE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "414-232-7277",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PSYD"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Mommas Pedestal",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.