Provider Demographics
NPI:1245512490
Name:NIKCHEVICH, NICOLE LYNN (MS, BCBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:NIKCHEVICH
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 PORTSMITH LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5211
Mailing Address - Country:US
Mailing Address - Phone:309-331-4189
Mailing Address - Fax:
Practice Address - Street 1:986 PORTSMITH LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5211
Practice Address - Country:US
Practice Address - Phone:309-331-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst