Nicole Fauquier, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.005267 Issued in IL

Practice address

854 Technology Way
Libertyville, IL 60048-5350

Phone

(847) 816-7200

NPI assigned

Aug 22, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole Brachfeld Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Mobile Therapy Centers of Tennessee, LLC

  • Behavior Analyst
  • Brentwood, TN
  • NPI 1689187247
  NPD (past)

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1205083011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7635",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600487635",
            "telephone_number": "847-816-7200",
            "fax_number": "847-816-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "854 TECHNOLOGY WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485350",
            "telephone_number": "847-816-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUQUIER",
        "first_name": "NICOLE",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-22",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.005267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BRACHFELD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Evolve North I PLLC
• Family Care Medical Group, SC
• Family Medicine of Illinois SC
• Family Partnership Associates
• Family Partnership Associates
• Alyson Favela, MSN, APRN, FNP-C
• Alexandria Fedro, DACM
• Kelly Fengya, DPT
• Ira F Fenton, DO
• Lindsey Ferguson

• Speech-Language Pathologist in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.