Active NPI
Shelly Nicol
- Clinical Psychologist
- Vancouver, WA
National Provider Identifier
1023244555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 60620544
- Practice address
- 7507 NE 51St St
Vancouver, WA 98662-6007 - Phone
- (360) 906-1190
- NPI assigned
- Jun 10, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 60620544 | WA | Primary |
Addresses
Primary practice location
7507 NE 51St St
Vancouver, WA 98662-6007
Mailing address
7507 NE 51St St
Vancouver, WA 98662-6007
Phone (360) 906-1190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60620544 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457049600000",
"number": "1023244555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7507 NE 51ST ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986626007",
"telephone_number": "360-906-1190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7507 NE 51ST ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986626007",
"telephone_number": "360-906-1190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOL",
"first_name": "SHELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-10",
"last_updated": "2016-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "60620544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.