Provider Demographics
NPI:1467599175
Name:NICKERSON & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:NICKERSON & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-752-9725
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-0239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1N141 COUNTY FARM RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2032
Practice Address - Country:US
Practice Address - Phone:630-752-9725
Practice Address - Fax:630-752-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
022-32734OtherBCBS GROUP NUMBER