Northern Illinois University

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

166000169 Issued in IL

Legal business name

NORTHERN ILLINOIS UNIVERSITY

Practice address

146 Wirtz Hall
Dekalb, IL 60115-3088

Phone

(815) 753-1684

Fax

(815) 753-1627

NPI assigned

Oct 8, 2010

Organization subpart

No

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

Authorized official

Name

Dawn Roznowski

Title

Assistant, Dean/Finance Operations

Phone

(815) 753-6161

Specialties & licenses 1

Addresses

Other names 1

• Family Center of NIU Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Northern Illinois University

  • Radiation Oncology Clinic/Center
  • Batavia, IL
  • NPI 1144327487

  O20050104000460

  Same enrollment
• Northern Illinois University

  • Physical Therapy Clinic/Center
  • Dekalb, IL
  • NPI 1194991216

  O20050104000460

  Same enrollment
• Northern Illinois University

  • Audiologist
  • Dekalb, IL
  • NPI 1407916836

  O20050104000460

  Same enrollment
• Northern Illinois University-Physical Therapy

  • Physical Therapy Clinic/Center
  • Dekalb, IL
  • NPI 1821251430

  O20050104000460

  Same enrollment

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1114237153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 WIRTZ HALL",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601153088",
            "telephone_number": "815-753-1684",
            "fax_number": "815-753-1627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 WIRTZ HALL",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601153088",
            "telephone_number": "815-753-1684",
            "fax_number": "815-753-1627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ILLINOIS UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-08",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "ROZNOWSKI",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "ASSISTANT, DEAN/FINANCE OPERATIONS",
        "authorized_official_telephone_number": "815-753-6161"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166000169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Center of NIU",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Nipp, RN
• Charles Houston Nobles, CRNA
• Northern Illinois Endodontics, LTD
• Northern Illinois Fertility SC
• Northern Illinois Imaging Specialists LLC
• Northern Illinois University
• Northern Illinois University
• Northern Illinois University
• Northern Illinois University
• Northern Illinois University

• All providers in Dekalb, IL
• Marriage & Family Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.