NPIMap

Individual provider Active NPI

Nicole A Stotzheim, BCBA

  • Behavior Analyst
  • De Pere, WI
National Provider Identifier
1497319743
Registry record updated Apr 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
289-140 Issued in WI
Practice address
1141 W Main Ave Ste 201
De Pere, WI 54115-1695
Phone
(920) 338-1610
Fax
(920) 338-1616
NPI assigned
Apr 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2019

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 289-140 WI Primary

Addresses

Primary practice location

1141 W Main Ave Ste 201
De Pere, WI 54115-1695

Mailing address

1210 Fourier Dr Ste 100
Madison, WI 53717-1969
Phone (608) 662-9327

Other names 1

  • Nicole A Radue Former name

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
289-140WIMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Autism Spectrum Therapies of Delaware, LLC Behavior Analyst Past Accepting new patients

Organizations & group practices 1

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": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1497319743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 FOURIER DR STE 100",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171969",
            "telephone_number": "608-662-9327",
            "fax_number": "608-662-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 W MAIN AVE STE 201",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151695",
            "telephone_number": "920-338-1610",
            "fax_number": "920-338-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOTZHEIM",
        "first_name": "NICOLE",
        "middle_name": "A",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-23",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "289-140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "RADUE",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.