Individual provider Active NPI

Nicole Lynn Nikchevich, M.S., BCBA

  • Behavior Analyst
  • Bolingbrook, IL
National Provider Identifier
1245512490
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
986 Portsmith LN
Bolingbrook, IL 60440-5211
Phone
(309) 331-4189
NPI assigned
Sep 14, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X IL Primary

Addresses

Primary practice location

986 Portsmith LN
Bolingbrook, IL 60440-5211

Mailing address

986 Portsmith LN
Bolingbrook, IL 60440-5211
Phone (309) 331-4189

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
Credentials
Master of Science

NPI Registry JSON

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

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1245512490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "986 PORTSMITH LN",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604405211",
            "telephone_number": "309-331-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "986 PORTSMITH LN",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604405211",
            "telephone_number": "309-331-4189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKCHEVICH",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "credential": "M.S., BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-14",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.