Amber Elise Vicic

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

21701 Gougar Rd
New Lenox, IL 60451-1576

Phone

(815) 878-4835

NPI assigned

Apr 11, 2018

Last updated

Jun 29, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1871090225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21701 GOUGAR RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604511576",
            "telephone_number": "815-878-4835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21701 GOUGAR RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604511576",
            "telephone_number": "815-878-4835"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2081 Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Minooka",
            "state": "IL",
            "postal_code": "604478848",
            "country_code": "US",
            "telephone_number": "815-467-1612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICIC",
        "first_name": "AMBER",
        "middle_name": "ELISE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2022-06-29",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Lee Veerman, D.C.
• Justin Velarde, DPT
• Mark Theodore Veldman, D.O,
• Raechel Verbiscar
• Michelle Verheyen, LPC, NCC
• Dario Martin Villamar, M.D.
• Lauren Nicole Voss, PA
• Ashish Vyas, MD
• Michelle Wachtor, PHARMD
• Kristin Wagner, PT

• Athletic Trainer in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.