Nicole Angela Kelley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149011400 Issued in IL

Practice address

112 Boeykens PL
Suite 4a
Normal, IL 61761-2152

Phone

(309) 242-7925

Fax

(309) 454-9521

NPI assigned

Sep 2, 2006

Last updated

Mar 30, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 29, 2023 through Mar 29, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1659473437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 N WASHINGTON ST",
            "city": "HUDSON",
            "state": "IL",
            "postal_code": "617489476",
            "telephone_number": "309-242-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 BOEYKENS PL",
            "address_2": "SUITE 4A",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612152",
            "telephone_number": "309-242-7925",
            "fax_number": "309-454-9521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "NICOLE",
        "middle_name": "ANGELA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149011400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bijoy Shankar Kar, M.D.
• Brad R Kaufmann, C.R.N.A.
• William O Kauth Sr., PH.D, ATC
• Benjamin Keating, M.D.
• Carrie Keller, BS
• Adam Richard Kelly, ATC
• Thomas Charles Kelly, MD
• Kristin Kendrick
• Susan M Keogh, LCPC
• Caitlin Keroack, ATC

• Clinical Social Worker in Normal, IL
• Providers in Normal, 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 Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.