Nicole Marie De Valk, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1379--124 Issued in WI

Practice address

145 W Wisconsin Ave
Neenah, WI 54956-3075

Phone

(920) 725-1230

Fax

(920) 215-6164

NPI assigned

Jun 26, 2019

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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.

• Kimberley Welk and Associates, LLC

  • Marriage & Family Therapist
  • Green Bay, WI
  • NPI 1487075214
  NPD (past)
• Radiology Associates of the Fox Valley, SC

  • Diagnostic Radiology Physician
  • Neenah, WI
  • NPI 1477539443
  NPD (past)

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1417518812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 W WISCONSIN AVE",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563075",
            "telephone_number": "920-725-1230",
            "fax_number": "920-215-6164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 W WISCONSIN AVE",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563075",
            "telephone_number": "920-725-1230",
            "fax_number": "920-215-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE VALK",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-26",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "1379--124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100090606",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexander Dassow, RD, CD
• Diane Elizabeth Daugharty, FNP
• Katherine Davenport, PHARMD
• Laura L Davis, APNP
• Scott Davis, MD
• Robert E Dedmon, MD
• Dana Michelle Defta, MD
• William Rodney Degoey, OT
• Junting Liu Degrood, MD
• Ethan M Delekta, PA-C

• Marriage & Family Therapist in Neenah, WI
• Providers in Neenah, WI by specialty
• Marriage & Family Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.