KENNETH VICENCIO (NPI# 1891211710) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891211710 |
| Entity Type | Individual |
| Full Name | KENNETH VICENCIO |
| Credential | PSYD |
| Practice Address |
4100 Healthway Drive Aurora IL 60504 |
| Mailing Address |
4100 Healthway Dr Aurora IL 60504-4163 |
| Practice Telephone | 6314553070 |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2018-03-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 071009682 | IL | Behavioral Health & Social Service Providers |
| N | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers |
| Street Address |
4100 HEALTHWAY DRIVE |
| City | AURORA |
| State | IL |
| Zip Code | 60504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134631039 | Kamala Lakshmipathy | Physical Therapist | 2021 Randi Drive, Aurora, IL 60504 | 2017-10-31 |
| 1316499023 | Wilcox and Wilcox, Inc | Home Health | 75 Executive Drive, Suite 301, Aurora, IL 60504 | 2016-10-28 |
| 1518315241 | Kinsley Jin | Family Medicine | Rush-copley Family Medicine Center 2020 Ogden Avenue, Suite 330, Aurora, IL 60504 | 2016-06-03 |
| 1609224211 | Empower Health Services, LLC | Clinic/Center | 4205 Westbrook Dr, Aurora, IL 60504 | 2016-05-25 |
| 1275907883 | Lolita Lajoyce Norris | Private Vehicle | 235 Kirkland Ln, Aurora, IL 60504 | 2015-11-19 |
| 1972917557 | Elizabeth Sledge | Occupational Therapist | 1000 Celebration Dr, Aurora, IL 60504 | 2014-06-11 |
| 1962840330 | Sparc Chiropractic, P.C. | Chiropractor | 800-2 Frontenac Road, #2, Aurora, IL 60504 | 2013-06-07 |
| 1932451952 | Illinois Health Resources Inc | Physical Therapist | 1240 S Commons Dr, Aurora, IL 60504 | 2012-10-15 |
| 1376894501 | Rush-copley Medical Group | Family Medicine | 2040 Ogden Ave., Suite 304, Aurora, IL 60504 | 2012-09-27 |
| 1851673081 | Ronald Craig Miller | Pharmacist | 1857 Foxfield Dr., Apt 2, Aurora, IL 60504 | 2011-09-14 |
| Find all providers in zip 60504 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184885535 | Kevin Barry Kells | Clinical Neuropsychologist | 6393 S Richfield St, Aurora, CO 80016-3170 | 2008-06-18 |
| 1235247560 | Georganne R Bley | Clinical Neuropsychologist | 14111 E Alameda Ave Ste 200, Aurora, CO 80012-2509 | 2006-08-27 |
| 1578186094 | Joie Molden | Clinical Neuropsychologist | 12605 E 16th Ave, Aurora, CO 80045-2545 | 2020-05-19 |
| 1124671045 | Lauren Haisley | Clinical Neuropsychologist | 13123 E 16th Ave, Aurora, CO 80045 | 2019-07-19 |
| 1154707594 | Andrea S. Miele | Clinical Neuropsychologist | 13123 E 16th Ave, B155, Aurora, CO 80045-7106 | 2015-08-08 |
| 1366820086 | Kelly Wolfe | Clinical Neuropsychologist | 13123 E 16th Ave, B 155, Aurora, CO 80045-7106 | 2015-05-14 |
| 1336579366 | Brianne Bettcher | Clinical Neuropsychologist | 12605 E 16th Ave, Aurora, CO 80045-2545 | 2013-11-12 |
| 1215284419 | Christopher Domen | Clinical Neuropsychologist | 12605 E 16th Ave, University of Colorado Hospital, Aurora, CO 80045-2545 | 2012-08-07 |
| 1477809770 | Gretchen Berrios-siervo | Clinical Neuropsychologist | 13123 E 16th Ave, Box155, Aurora, CO 80045-7106 | 2012-07-24 |
| 1669759981 | Joseph John Coda | Clinical Neuropsychologist | 2285 Sequoia Dr, Aurora, IL 60506-6209 | 2011-11-15 |
| Find all providers in AURORA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.