Provider Demographics
NPI:1346739422
Name:VINCI, NICOLE (RBT-17-41711)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:VINCI
Suffix:
Gender:F
Credentials:RBT-17-41711
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2487 STONEGATE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6403
Mailing Address - Country:US
Mailing Address - Phone:847-636-6689
Mailing Address - Fax:
Practice Address - Street 1:402 FEDERAL DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:920-857-9041
Practice Address - Fax:920-857-3366
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst