Organization Active NPI

Nickerson & Associates, P.C.

  • Clinical Psychologist
  • Winfield, IL
National Provider Identifier
1467599175
Registry record updated Mar 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
NICKERSON & ASSOCIATES, P.C.
Practice address
1N141 County Farm Rd
Suite 130
Winfield, IL 60190-2032
Phone
(630) 752-9725
Fax
(630) 752-9726
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2009

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

Authorized official

Name
Debra Nickerson, PSY.D.
Title
President
Phone
(630) 752-9725

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1N141 County Farm Rd
Suite 130
Winfield, IL 60190-2032

Mailing address

PO Box 239
Winfield, IL 60190-0239

Other identifiers 1

IdentifierTypeStateIssuer
022-32734OtherBCBS GROUP NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236297600000",
    "number": "1467599175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 239",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601900239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1N141 COUNTY FARM RD",
            "address_2": "SUITE 130",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601902032",
            "telephone_number": "630-752-9725",
            "fax_number": "630-752-9726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICKERSON & ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2009-03-06",
        "status": "A",
        "authorized_official_last_name": "NICKERSON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-752-9725",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "022-32734",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; 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.