Individual provider Active NPI

Nicole Fisk, LLP

  • Clinical Psychologist
  • Rochester Hills, MI
National Provider Identifier
1164276283
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6361007656 Issued in MI
Practice address
1135 Ruby Ave
Rochester Hills, MI 48309-4347
Phone
(248) 568-4834
NPI assigned
Apr 15, 2024
Last updated
Apr 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6361007656 MI Primary

Addresses

Primary practice location

1135 Ruby Ave
Rochester Hills, MI 48309-4347

Mailing address

1135 Ruby Ave
Rochester Hills, MI 48309-4347

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6361007656MIMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1164276283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 RUBY AVE",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483094347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 RUBY AVE",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483094347",
            "telephone_number": "248-568-4834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISK",
        "first_name": "NICOLE",
        "credential": "LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6361007656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.