Nicole Brister, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

291 Macintosh Ave
Woodstock, IL 60098-7623

Phone

(630) 605-3697

NPI assigned

Jan 26, 2022

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1831841378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 MACINTOSH AVE",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987623",
            "telephone_number": "630-605-3697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 MACINTOSH AVE",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987623",
            "telephone_number": "630-605-3697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8600 US Highway 14 Ste 108",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600122700",
            "country_code": "US",
            "telephone_number": "815-975-7353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRISTER",
        "first_name": "NICOLE",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-26",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Konstantina Marie Borowski
• Jennifer Lynn Boston, MSW, LCSW
• Amadea I Brayden, LIC.AC.
• Andrew Lawrence Breen
• Kathryn Brierley, M.A., CCC-A
• Kelly M Broederdorf, REGISTERED NURSE
• Janet Loraine Brundage, LCSW
• Douglas H Bryan, MD
• Robert Leslie Buckley, MD
• Stephanie Alexandria Bui, DO

• Speech-Language Pathologist in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.