Active NPI
Nicole Shepherd
- Developmental Therapist
- Villa Park, IL
National Provider Identifier
1669237186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 18W261 Knollwood LN
Villa Park, IL 60181-3636 - Phone
- (630) 487-7405
- NPI assigned
- Feb 14, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
18W261 Knollwood LN
Villa Park, IL 60181-3636
Mailing address
18W261 Knollwood LN
Villa Park, IL 60181-3636
Phone (630) 487-7405
Other names 1
- Nicole Robertson
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707868800000",
"number": "1669237186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18W261 KNOLLWOOD LN",
"city": "VILLA PARK",
"state": "IL",
"postal_code": "601813636",
"telephone_number": "630-487-7405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18W261 KNOLLWOOD LN",
"city": "VILLA PARK",
"state": "IL",
"postal_code": "601813636",
"telephone_number": "630-487-7405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-14",
"last_updated": "2024-02-14",
"certification_date": "2024-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "ROBERTSON",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Villa Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.