Nyssa Knickerbocker

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1604 1St St S Ste 120
Willmar, MN 56201-4243

Phone

(320) 403-5247

NPI assigned

Jan 10, 2019

Last updated

Jan 10, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nolan's Place LLC

  • Behavior Technician
  • Willmar, MN
  • NPI 1154826469
  NPD (past)

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547078400000",
    "number": "1689147746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 1ST ST S STE 120",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014243",
            "telephone_number": "320-403-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 1ST ST S STE 120",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014243",
            "telephone_number": "320-403-5247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNICKERBOCKER",
        "first_name": "NYSSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-10",
        "last_updated": "2019-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Allyn Klein, L.A.D.C.
• Merlin N Kleinhuizen, DDS
• Juli Kay Klindt, BS, LADC
• Courtney Marie Klinkhammer, MD
• John Arvin Klopfleisch, LICSW
• Barbara Lynn Knott, PCA
• Knuston Counseling and Seminars, Inc.
• Knutson Counseling & Seminars, Inc.
• Tamara L Kobienia, PHYSICAL THERAPIST
• Chelsie Jo Koch, LICSW

• Behavior Technician in Willmar, MN
• Providers in Willmar, MN by specialty
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.