Active NPI
Nichole Rae Hanneken Ontis, M.S., CCC-SLP
- Speech-Language Pathologist
- Roxana, IL
National Provider Identifier
1255835567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146010146
- Practice address
- 401 Chaffer Ave
Roxana, IL 62084-1125 - Phone
- (618) 254-7369
- NPI assigned
- Mar 21, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146010146 | IL | Primary |
Addresses
Primary practice location
401 Chaffer Ave
Roxana, IL 62084-1125
Mailing address
401 Chaffer Ave
Roxana, IL 62084-1125
Phone (618) 254-7369
Other names 1
- Nichole Rae Hanneken
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146010146 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521590400000",
"number": "1255835567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 CHAFFER AVE",
"city": "ROXANA",
"state": "IL",
"postal_code": "620841125",
"telephone_number": "618-254-7369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 CHAFFER AVE",
"city": "ROXANA",
"state": "IL",
"postal_code": "620841125",
"telephone_number": "618-254-7369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANNEKEN ONTIS",
"first_name": "NICHOLE",
"middle_name": "RAE",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-21",
"last_updated": "2018-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146010146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NICHOLE",
"last_name": "HANNEKEN",
"middle_name": "RAE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Roxana, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.