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General NPI Number Information
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NPI Number | 1467599175
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Entity Type | Organization
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Legal Business Name | NICKERSON & ASSOCIATES, P.C.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 1N141 COUNTY FARM RD SUITE 130
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City | WINFIELD
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State | IL
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Zip | 60190-2032
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Country | US
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Telephone | 630-752-9725
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Fax | 630-752-9726
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Provider Business Mailing Address
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Address Line | PO BOX 239
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City | WINFIELD
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State | IL
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Zip | 60190-0239
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBRA NICKERSON
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Credential | PSY.D.
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Telephone | 630-752-9725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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