Nicole Elizabeth Rundall-Royal, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149021663 Issued in IL

Practice address

1302 Thoren LN
Rockford, IL 61107-2662

Phone

(815) 978-6465

NPI assigned

Dec 27, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1577404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1538708243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 THOREN LN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611072662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 THOREN LN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611072662",
            "telephone_number": "815-978-6465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNDALL-ROYAL",
        "first_name": "NICOLE",
        "middle_name": "ELIZABETH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-27",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149021663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerardo Rubio
• Judith L Ruch
• John P. Rudzinski, MD
• Leigh A. Ruelo, PA-C
• Laura Anne Ruffner, M.S., CCC-SLP
• Thomas A Runne, DPM
• William J Runne, DDS
• Rachel Runyard, WHNP
• Elissa Russell, APN, CNP
• John Russell

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.