1528197621 NPI number — MRS. NICOLE TATIANA COCHRANE M.ED., LCPC

Table of content: MRS. NICOLE TATIANA COCHRANE M.ED., LCPC (NPI 1528197621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528197621 NPI number — MRS. NICOLE TATIANA COCHRANE M.ED., LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCHRANE
Provider First Name:
NICOLE
Provider Middle Name:
TATIANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEFANSKI
Provider Other First Name:
NICOLE
Provider Other Middle Name:
TATIANA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.P.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528197621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
872 TAM O SHANTER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-669-6033
Provider Business Mailing Address Fax Number:
630-324-7147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5117 MAIN ST.
Provider Second Line Business Practice Location Address:
DG COMMONS LOWER LEVEL # 13
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-669-6033
Provider Business Practice Location Address Fax Number:
630-324-7147
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180006143 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 180006143 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2300602 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 02233003 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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