Nesquehoning Creek originates both in a forested area on the slopes of Broad Mountain at an elevation somewhat in excess of 1360 ft on USGS topological maps, as well as above Tamaqua Gap cut by the Little Schuylkill River and Tamaqua in a saddle pass connecting with Broad Mountain. It flows south for about then turns to the northeast and flows into Greenwood Lake. Approximately downstream from the spillway, it discharges into Lake Hauto. It then continues to the northeast in a relatively narrow valley flowing past the ravine now traversed by US 209 climbing up Room Run to the upper foot of Mount Pisgah above the divide from Panther Creek. The stream then travels down a narrow undeveloped section to its confluence with the Lehigh River.