Nicole Gilliam, SAC-IT, LPC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

20912 Issued in WI

Practice address

3825 39TH Ave Ste 120
Kenosha, WI 53144-2043

Phone

(262) 946-5752

NPI assigned

Sep 27, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Addiction Services and Pharmacotherapy, SC

  • Methadone Clinic
  • Kenosha, WI
  • NPI 1538820790
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759881600000",
    "number": "1487527156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3825 39TH AVE STE 120",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531442043",
            "telephone_number": "262-946-5752",
            "fax_number": "262-946-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 39TH AVE STE 120",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531442043",
            "telephone_number": "262-946-5752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "NICOLE",
        "credential": "SAC-IT, LPC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-27",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "20912",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "8673",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Gerard Gilbertson II, M.D.
• Sydney Gille, PT
• Cassandra Gillen, LPC
• Jessica Lynn Gillengerten, L.AC.
• Erin Gillespie, FNP
• Megan Lee Girard
• Suzanne Girard, NP
• Mary C Girsh-Jensen, LCSW CSAC
• Casey Nicole Gittens
• Kristina M Gittens, NP

• Addiction (Substance Use Disorder) Counselor in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.