Nicole Ellish, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

11725028 Issued in IL

Practice address

10450 72ND Ave
Pleasant Prairie, WI 53158-2911

Phone

(262) 657-6453

NPI assigned

Apr 5, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Nicole Spiel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Sonnenberg Consultants LLC

  • Behavior Analyst
  • Franksville, WI
  • NPI 1083929749
  NPD (past)
• Community Living in Kentucky, LLC

  • Community/Behavioral Health Agency
  • Murray, KY
  • NPI 1518281419

  Behavior Analyst

  NPD (past)
• Gateway Counseling Services

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1508278458
  NPD (past)

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

{
    "created_epoch": "1491350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601683200000",
    "number": "1689107716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51322",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421025622",
            "telephone_number": "270-777-9283",
            "fax_number": "270-777-9283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10450 72ND AVE",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531582911",
            "telephone_number": "262-657-6453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18550 W Millburn Rd",
            "address_purpose": "LOCATION",
            "city": "Old Mill Creek",
            "state": "IL",
            "postal_code": "600839248",
            "country_code": "US",
            "telephone_number": "803-905-4427",
            "fax_number": "803-905-4431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6116 Lake Shore Dr",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "IL",
            "postal_code": "600131270",
            "country_code": "US",
            "telephone_number": "224-639-9979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLISH",
        "first_name": "NICOLE",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-05",
        "last_updated": "2020-10-03",
        "certification_date": "2020-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": "11725028",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "176-140",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SPIEL",
            "credential": "BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Duguay, DPT
• Danielle Dutkiewicz, CFSA
• Amy Eiden, OTR
• Alyssa Eirich
• Kimberly Ellefson, PTA
• Jennifer Erich, APNP
• Buckley Fechter, MD, MS
• Joseph Conrad Foelker, PHARMD
• Forefront Dermatology SC
• Forefront Dermatology, S.C.

• Behavior Analyst in Pleasant Prairie, WI
• Providers in Pleasant Prairie, WI by specialty
• Behavior Analyst in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2020; 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.