Elissa Blake Noble, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071007387 Issued in IL

Practice address

300 E Roosevelt Rd
Suite 105
Wheaton, IL 60187-1908

Phone

(630) 534-3136

NPI assigned

Sep 26, 2007

Sex

Female

Sole proprietor

Yes

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.

• Nicholas & Noble Psychological Associates

  • Clinical Psychologist
  • Wheaton, IL
  • NPI 1003340027
  NPD (past) Authorized official CLINICAL

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 18, 2019 through Jan 18, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 5, 2016.

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470355200000",
    "number": "1821285693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E ROOSEVELT RD",
            "address_2": "SUITE 105",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601871908",
            "telephone_number": "630-534-3136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E ROOSEVELT RD",
            "address_2": "SUITE 105",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601871908",
            "telephone_number": "630-534-3136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE NOBLE",
        "first_name": "ELISSA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-26",
        "last_updated": "2016-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Bingham
• David Thomas Birkhahn-Rommelfanger
• Rima I Birutis, MA, CCC-SLP
• Kimberly R Blachuciak, RN
• Janelle Blackwell
• Guadalupe G Blanco
• Kimberly Diane Blankshain, MD
• Angela Blatner, MPT
• Gerald Aaron Blechman, PH.D.
• Regina Bledsoe-Flowers, RN

• All providers in Wheaton, IL
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.