Individual provider Active NPI

Natalie Olivia Nordlund

  • Psychologist
  • Victor, NY
National Provider Identifier
1366114332
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5239-57 Issued in WI
Practice address
6539 Anthony Dr Ste a
Victor, NY 14564-1441
Phone
(585) 398-8835
Fax
(585) 398-7376
NPI assigned
Sep 29, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 4372491 NY
School Psychologist 103TS0200X 3001026894 WI
Psychologist 103T00000X 5239-57 WI Primary

Addresses

Primary practice location

6539 Anthony Dr Ste a
Victor, NY 14564-1441

Mailing address

6539 Anthony Dr Ste a
Victor, NY 14564-1441
Phone (585) 398-8835

Other practice location 1

1720 W Florist Ave Ste 125
Glendale, WI 53209-3862
Phone (414) 247-0801

Other practice location 2

242 W Main St Apt 408
Rochester, NY 14614-1147
Phone (515) 571-0848

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
5239-57WIMDPsychologist
4372491NYMDSchool Psychologist
3001026894WIMDSchool Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sebastian Family Psycholgy Practice PastSince Oct 1, 2021 Accepting new patients
Sebastian Family Psycholgy Practice PastSince Oct 1, 2021 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1366114332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6539 ANTHONY DR STE A",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145641441",
            "telephone_number": "585-398-8835",
            "fax_number": "585-398-7376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6539 ANTHONY DR STE A",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145641441",
            "telephone_number": "585-398-8835",
            "fax_number": "585-398-7376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1720 W Florist Ave Ste 125",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "WI",
            "postal_code": "532093862",
            "country_code": "US",
            "telephone_number": "414-247-0801",
            "fax_number": "414-247-0816",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "242 W Main St Apt 408",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146141147",
            "country_code": "US",
            "telephone_number": "515-571-0848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NORDLUND",
        "first_name": "NATALIE",
        "middle_name": "OLIVIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NY",
            "license": "4372491",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "WI",
            "license": "3001026894",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "5239-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victor, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.