Healthcare Provider Details

I. General information

NPI: 1912566688
Provider Name (Legal Business Name): NINA NIELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SEMINARY AVE
AURORA IL
60505-4768
US

IV. Provider business mailing address

10S190 ALAGO RD
NAPERVILLE IL
60564-9621
US

V. Phone/Fax

Practice location:
  • Phone: 630-299-5500
  • Fax:
Mailing address:
  • Phone: 708-250-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2417565
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: